Paymon M Azizi1,2, Duminda N Wijeysundera1,3, Harindra C Wijeysundera1,2,4,5, Peter C Austin1,2,5, Angela Jerath2, Lu Han2, Maria Koh2, Dennis T Ko6,7,8. 1. Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada. 2. ICES, Toronto, ON, Canada. 3. Department of Anesthesia, St Michael's Hospital, Toronto, ON, Canada. 4. Schulich Heart Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada. 5. Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada. 6. Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada. dennis.ko@ices.on.ca. 7. ICES, Toronto, ON, Canada. dennis.ko@ices.on.ca. 8. Schulich Heart Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada. dennis.ko@ices.on.ca.
Abstract
BACKGROUND: International practice guidelines make different recommendations for postoperative troponin testing to detect perioperative myocardial infarction and myocardial injury after noncardiac surgery. To gain insights into current testing patterns, we evaluated predictors of routine troponin testing after three commonly performed major noncardiac surgeries. METHODS: We conducted a population-based historical cohort study of adults having major orthopedic, colorectal, or vascular surgery in Ontario, Canada from 1 January 2010 to 31 December 2017. We used hierarchical logistic regression modelling to assess the association of patient, surgery, and hospital factors with postoperative troponin testing, while accounting for clustering at the hospital level. We characterized hospital-level variation by the intraclass correlation coefficient (ICC), which was adjusted for various characteristics. RESULTS: The cohort included 176,454 eligible patients. Hospital-specific adjusted testing rates ranged from 0-20.1% for orthopedic surgery, 0-43.8% for colorectal surgery, and 19.6-88.0% for vascular surgery. Older age, urgent surgery status, and surgery duration were consistently associated with higher rates of testing for all three surgeries. Higher Revised Cardiac Risk Index scores were associated with higher odds of testing for orthopedic and colorectal surgery, but not for vascular surgery. Even after adjustment, the ICCs were 9.2%, 7.4%, and 24.1% for orthopedic, general, and vascular surgery, respectively. CONCLUSIONS: Troponin testing varied substantially across hospitals for selected major noncardiac surgery procedures even after accounting for differences in patient-level cardiac risk factors. Our observations lend support to a more standardized approach for troponin testing after noncardiac surgery.
BACKGROUND: International practice guidelines make different recommendations for postoperative troponin testing to detect perioperative myocardial infarction and myocardial injury after noncardiac surgery. To gain insights into current testing patterns, we evaluated predictors of routine troponin testing after three commonly performed major noncardiac surgeries. METHODS: We conducted a population-based historical cohort study of adults having major orthopedic, colorectal, or vascular surgery in Ontario, Canada from 1 January 2010 to 31 December 2017. We used hierarchical logistic regression modelling to assess the association of patient, surgery, and hospital factors with postoperative troponin testing, while accounting for clustering at the hospital level. We characterized hospital-level variation by the intraclass correlation coefficient (ICC), which was adjusted for various characteristics. RESULTS: The cohort included 176,454 eligible patients. Hospital-specific adjusted testing rates ranged from 0-20.1% for orthopedic surgery, 0-43.8% for colorectal surgery, and 19.6-88.0% for vascular surgery. Older age, urgent surgery status, and surgery duration were consistently associated with higher rates of testing for all three surgeries. Higher Revised Cardiac Risk Index scores were associated with higher odds of testing for orthopedic and colorectal surgery, but not for vascular surgery. Even after adjustment, the ICCs were 9.2%, 7.4%, and 24.1% for orthopedic, general, and vascular surgery, respectively. CONCLUSIONS: Troponin testing varied substantially across hospitals for selected major noncardiac surgery procedures even after accounting for differences in patient-level cardiac risk factors. Our observations lend support to a more standardized approach for troponin testing after noncardiac surgery.
Authors: Lee A Fleisher; Kirsten E Fleischmann; Andrew D Auerbach; Susan A Barnason; Joshua A Beckman; Biykem Bozkurt; Victor G Davila-Roman; Marie D Gerhard-Herman; Thomas A Holly; Garvan C Kane; Joseph E Marine; M Timothy Nelson; Crystal C Spencer; Annemarie Thompson; Henry H Ting; Barry F Uretsky; Duminda N Wijeysundera Journal: Circulation Date: 2014-08-01 Impact factor: 29.690
Authors: Paymon M Azizi; Duminda N Wijeysundera; Harindra C Wijeysundera; Peter C Austin; Angela Jerath; Lu Han; Maria Koh; Dennis T Ko Journal: CJC Open Date: 2021-03-26
Authors: Lorraine L Lipscombe; Jeremiah Hwee; Lauren Webster; Baiju R Shah; Gillian L Booth; Karen Tu Journal: BMC Health Serv Res Date: 2018-05-02 Impact factor: 2.655