Abstract

Background: To assess the relationship between perioperative elevation of Troponin I and one-year survival after orthopaedic surgery in older patients with fracture.

Methods: This prospective observational study was conducted from May 2014 to June 2015. 97 older patients (age>65 years) with orthopaedic surgery after fracture were included in the study. Troponin I was measured at the next day of admission, the first and the fifth day after surgery, respectively. Patients with elevated Troponin I in any of 3 time points were divided into the elevated group. All patients received at least one-year follow-up by telephone. All caused one-year mortality was recognized as the primary end-point.

Results: Perioperative elevated serum Troponin I (>0.03 mg/L) were found in 37.1% patients (36/97). In the one-year follow-up, 4 patients were lost with the follow-up rate 95.9%. Seventeen patients died during one-year follow-up, the cumulative all caused one-year mortality was 17.5%. The cumulative mortality rate was higher in the elevated Troponin I group, compared with the normal Troponin I group (27.8% Vs. 11.5%; Log Rank Chi-Square = 5.647, p = 0.015). The crude HR was 2.885, with 95% CI 1.105 7.627. Multivariate analyze by Cox proportional hazards model showed the adjusted HRs were 2.319 (95% CI 1.1204.479) for perioperative elevated Troponin I and 2.375 (95% CI 1.1314.488) for preoperative elevated Troponin I.

Conclusion: Elevated perioperative Troponin I level decreases one-year survival after orthopaedic surgery in older patients with fracture. We suggest routine surveillance and earlier diagnosis together with appropriate treatment of cardiac event should be given in older fracture patients at perioperative period and later follow-up.