Relation of perioperative elevation of troponin to long-term mortality after orthopedic surgery.
Relation of perioperative elevation of troponin to long-term mortality after orthopedic surgery.
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骨膜手术后肌活动升高与长期死亡率的关系。
DOI：
10.1016/j.amjcard.2015.03.003
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发表时间：
2015-06-15
期刊：
影响因子：
--
通讯作者：
Berger JS
中科院分区：
文献类型：
--
作者：
Oberweis BS;Smilowitz NR;Nukala S;Rosenberg A;Xu J;Stuchin S;Iorio R;Errico T;Radford MJ;Berger JS
非心脏手术围手术期心肌坏死与短期死亡率相关，但对长期结局的影响尚未明确。我们在一项回顾性研究中调查了接受大型骨科手术的受试者围手术期肌钙蛋白升高与长期死亡率之间的关系。我们对2008年11月1日至2009年12月31日期间接受髋关节、膝关节和脊柱手术的连续受试者进行了长期随访研究。使用医院管理数据集确定患者人口统计学和合并症。记录围术期心肌坏死和ICD-9编码的心肌梗死（MI）。使用社会保障死亡指数（SSDI）数据库评估长期生存率。Logistic回归模型用于确定长期死亡率的独立预测因子。共有3，075名受试者接受了骨科手术。平均年龄为60.7岁，大多数受试者（59%）为女性。测量了1060例（34.5%）受试者的术后肌钙蛋白。179例（5.3%）受试者发生心肌坏死，20例（0.7%）编码为MI。在超过9，096患者年的随访中，发生了111例（3.6%）死亡。心肌坏死受试者的长期死亡率为16.8%，肌钙蛋白在正常范围的受试者为5.8%，围手术期肌钙蛋白未测量的受试者为1.5%。多变量校正后，围手术期肌钙蛋白升高（HR 2.33，CI 1.33 - 4.10）和编码的术后MI（校正HR 3.51，CI 1.44 - 8.53）与长期死亡率显著相关。术后心肌坏死在骨科手术后很常见。心肌坏死与长期死亡率独立相关，可用于识别心血管事件风险较高的受试者，这些受试者可从积极的心血管风险因素管理中获益。
Myocardial necrosis in the perioperative period of non-cardiac surgery is associated with short-term mortality, but the effect on long-term outcomes has not been characterized. We investigated the association between perioperative troponin elevation and long-term mortality in a retrospective study of subjects undergoing major orthopedic surgery. We performed a long-term follow-up study of consecutive subjects undergoing hip, knee, and spine surgery between November 1, 2008 and December 31, 2009. Patient demographics and comorbidities were ascertained using a hospital administrative dataset. Perioperative myocardial necrosis and ICD-9 coded myocardial infarction (MI) were recorded. Long-term survival was assessed using the Social Security Death Index (SSDI) database. Logistic regression models were used to identify independent predictors of long-term mortality. A total of 3,075 subjects underwent orthopedic surgery. Mean age was 60.7 years and a majority of subjects (59%) were female. Post-operative troponin was measured in 1060 (34.5%) subjects. Myocardial necrosis occurred in 179 (5.3%%) subjects and MI was coded in 20 (0.7%). Over 9,096 patient-years of follow up, 111 (3.6%) deaths occurred. Long-term mortality was 16.8% among subjects with myocardial necrosis, 5.8% with a troponin in the normal range, and 1.5% when a perioperative troponin was not measured. Perioperative troponin elevation (HR 2.33, CI 1.33 – 4.10) and coded post-operative MI (adjusted HR 3.51, CI 1.44 – 8.53) were significantly associated with long-term mortality after multivariable adjustment. Post-operative myocardial necrosis is common following orthopedic surgery. Myocardial necrosis is independently associated with long-term mortality and may be used to identify subjects at higher risk for cardiovascular events who may benefit from aggressive management of cardiovascular risk factors.
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影响因子：
8.8
作者：
Ausset, Sylvain;Auroy, Yves;Lenoir, Bernard
通讯作者：
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影响因子：
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DOI：
10.1016/j.injury.2008.01.025
发表时间：
2008-07-01
影响因子：
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作者：
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