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Pre-operative Troponin I as a Predictor of Morbidity and Mortality in Emergency General Surgery: An Analysis using American College of Surgeons National Surgical Quality Improvement Program (NSQIP) Database.
*Asha Zimmerman, *Jayson Marwaha, David Harrington, Daithi Heffernan, Andrew Stephen
Brown University, Providence, RI
Objective:
To determine if pre-operative troponin I elevation (PTE) in emergency general surgery patients is associated with post-operative morbidity and mortality.
Design:
Retrospective cohort study.
Setting:
Two university associated referral hospitals.
Patients:
Emergency general surgery (EGS) patients entered into the NSQIP database between 2008-2014 aged 18 years and older who had a troponin I drawn.
Interventions:
None.
Main Outcome Measures:
Mortality and any NSQIP defined post-operative events including myocardial infarction, pulmonary embolus, surgical site infection, pneumonia.
Results:
464 EGS patients had troponin I measurements pre-operatively. 82 (18%) had pre-operative troponin elevations. Patients with PTE were more likely to have the following pre-operative factors: ventilator dependence within 48 hours of surgery (49% vs 11%;p<0.0001), acute renal failure (18%vs4%;p=0.002), transfusion requirement(18%vs8%;p=0.031), and septic shock (40%vs13%;p<0.0001). Patient factors associated with PTE included: CHF (13%vs3%;p=0.007), dialysis dependence(16%vs3%;p=0.002), and ASA class 4 (52%vs29%;p<0.0001). Compared to controls, patients with PTE had higher rates of post-operative events (77% vs 52%;p<0.0001) and mortality (34% vs 13%;p=0.009). Univariate analysis showed patients with PTE had an increased risk of post-operative events(OR 3.02;95%CI 1.74-5.25) and mortality(OR 3.53;95%CI 1.66-7.47). Multivariate analysis did not reveal PTE as an independent risk for post-operative events or mortality.
Conclusions:
Emergency general surgery patients with PTE are at increased risk for post-operative events and death. Although not an independent risk factor, PTE has prognostic utility and can prepare surgical teams for adverse events so that they can be recognized, evaluated, and treated earlier. PTE may also encourage earlier perioperative institution of cardioprotective measures such as beta blockers, HMG-CoA reductase inhibitors, and aspirin during a period of marked inflammation and physiologic stress.
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