Risk factors for major adverse cardiovascular events after osteoporotic hip fracture repair surgery. (April 2020)

• Record Type: Journal Article
• Authors: Araguas, M.A.; Herrera, A.; Garrido, I.; Mateo, J.; Mayoral, A.P.; Muñoz, M.
• Is Part Of: Injury. Volume 51(2020)Supplement 1
• Page Start: S30
• Page End: S36
• Publication Date: 2020-04
• Subjects: Osteoporotic hip fracture -- Cardiac biomarkers -- Major adverse cardio-vascular events; Wounds and injuries -- Surgery -- Periodicals; Accidents -- Periodicals; Wounds and Injuries -- surgery -- Periodicals; Lésions et blessures -- Chirurgie -- Périodiques; Electronic journals; Electronic journals; 617.1
• DOI: 10.1016/j.injury.2020.03.052
• Languages: English
• ISSNs: 0020-1383

Abstract

Highlights: Osteoporotic hip fracture repair has a high index of post-operative morbidly. Respiratory and cardio-vascular complications are the most common cause of death after the surgery. In this prospective study, elevated pre-operative levels of cardiac biomarkers showed an independent relationship with the presentation of major adverse cardio-vascular events. Preoperative red blood cell transfusion was the stronger independent risk factor for postoperative major adverse cardio-vascular events. Abstract: Osteoporotic hip fracture (OHF) is an increasingly frequent age-related pathology, which results in high rates of functional loss and mortality within the first year after surgery. This study assessed whether preoperative levels of brain natriuretic peptide (NT-proBNP) and troponin I were related to early occurrence (30d) of major adverse cardio-vascular events (MACE) after OHF repair surgery. During a 6-month period, perioperative clinical and analytical data from consecutive patients, without known history of cardiovascular disease and undergoing surgery for OHF repair at a single centre, were prospectively collected. MACE was defined as acute myocardial ischaemia or infarction, acute heart failure or cardiovascular death. amongst the 140 patients included, 23 (16.4%) developed postoperative MACE (MACE group) and 117 did not (Control group). Compared to those from control group, patients from MACE group were older, had poorer physical status (ASA III–IV), received preoperative red blood cell transfusion (RBCT) more frequently, presented with lower haemoglobin concentrations and higher NT-proBNP, creatinine and troponin I concentrations. Overall, RBCT requirements and 30d mortality rate were also higher in MACE group. However, in multivariate analysis, only preoperative RBCT, creatinine >1 mg/dL and NT-proBNP >450 pg/mL remained as independent preoperative risks factors for postoperative MACE, while 95% confidence intervals of odds ratios were wide. Though our findings require confirmation in a larger multicentre cohort, identifying risk factors for early postoperative MACE after OHF repair surgery, might facilitate assessing patients' risk prior to and following surgery, and targeting them the appropriate preventive and/or therapeutic interventions.