Journal of orthopaedic trauma · 2026
Preoperative High-Sensitivity Troponin and Risk of In-Hospital Mortality and Cardiac Events After Hip Fracture Surgery.
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Touré Aly, Okafor Kenechukwu, Medilien Bryan, Mather Rachel, Parry Joshua, Hernandez-Irizarry Roberto C, Bradley Caitlin A, Ahn Jaimo, Schenker Mara L
Аннотация
OBJECTIVES: To evaluate whether preoperative high-sensitivity cardiac troponin (hs-cTn) elevation predicted in-hospital cardiac events and mortality after hip fracture surgery, and whether surgical delay modified this relationship.
DESIGN: Retrospective cohort study.
SETTING: Single Level 1 trauma center in the United States.
PATIENT SELECTION CRITERIA: Adult patients who underwent hip fracture surgery between January 1, 2020, and December 31, 2024, and had a preoperative hs-cTn measurement as part of routine perioperative assessment were included.
OUTCOME MEASURES AND COMPARISONS: The primary outcome was a composite of in-hospital cardiac event or mortality. Secondary outcomes were in-hospital mortality and in-hospital cardiac events analyzed separately. Outcomes were compared across preoperative troponin categories defined as normal (<30 ng/L), elevated (30-100 ng/L), and significantly elevated (>100 ng/L), and across surgical delay categories defined as <24, 24-48, and >48 hours.
RESULTS: A total of 510 patients were included. The mean age was 76.3 ± 14.1 years, and 291 patients (57.1%) were female. Preoperative troponin was normal in 424 patients (83.1%), elevated in 58 patients (11.4%), and significantly elevated in 28 patients (5.5%). Thirty-five patients (6.9%) experienced the composite outcome. The composite outcome occurred in 19 of 424 patients (4.5%) with normal troponin, 6 of 58 patients (10.3%) with elevated troponin, and 10 of 28 patients (35.7%) with significantly elevated troponin ( P < 0.001). Mortality occurred in 8 of 424 patients (1.9%), 2 of 58 patients (3.4%), and 3 of 28 patients (10.7%), respectively ( P = 0.015). Cardiac events occurred in 13 of 424 patients (3.1%), 4 of 58 patients (6.9%), and 9 of 28 patients (32.1%), respectively ( P < 0.001). In adjusted models, elevated hs-cTn was associated with increased odds of the composite outcome (odds ratio 4.4, 95% confidence interval 1.1-17.9, P = 0.038), and significantly elevated troponin was associated with higher odds of the composite outcome (odds ratio 16.1, 95% confidence interval 3.6-72.4, P < 0.001). Higher American Society of Anesthesiologists class independently predicted the composite outcome and mortality, and longer length of stay was associated with cardiac events.
CONCLUSIONS: Preoperative hs-cTn elevation was independently associated with in-hospital cardiac events and mortality after hip fracture surgery. Troponin levels greater than 100 ng/L identified patients at highest risk, independent of surgical delay.
LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
DESIGN: Retrospective cohort study.
SETTING: Single Level 1 trauma center in the United States.
PATIENT SELECTION CRITERIA: Adult patients who underwent hip fracture surgery between January 1, 2020, and December 31, 2024, and had a preoperative hs-cTn measurement as part of routine perioperative assessment were included.
OUTCOME MEASURES AND COMPARISONS: The primary outcome was a composite of in-hospital cardiac event or mortality. Secondary outcomes were in-hospital mortality and in-hospital cardiac events analyzed separately. Outcomes were compared across preoperative troponin categories defined as normal (<30 ng/L), elevated (30-100 ng/L), and significantly elevated (>100 ng/L), and across surgical delay categories defined as <24, 24-48, and >48 hours.
RESULTS: A total of 510 patients were included. The mean age was 76.3 ± 14.1 years, and 291 patients (57.1%) were female. Preoperative troponin was normal in 424 patients (83.1%), elevated in 58 patients (11.4%), and significantly elevated in 28 patients (5.5%). Thirty-five patients (6.9%) experienced the composite outcome. The composite outcome occurred in 19 of 424 patients (4.5%) with normal troponin, 6 of 58 patients (10.3%) with elevated troponin, and 10 of 28 patients (35.7%) with significantly elevated troponin ( P < 0.001). Mortality occurred in 8 of 424 patients (1.9%), 2 of 58 patients (3.4%), and 3 of 28 patients (10.7%), respectively ( P = 0.015). Cardiac events occurred in 13 of 424 patients (3.1%), 4 of 58 patients (6.9%), and 9 of 28 patients (32.1%), respectively ( P < 0.001). In adjusted models, elevated hs-cTn was associated with increased odds of the composite outcome (odds ratio 4.4, 95% confidence interval 1.1-17.9, P = 0.038), and significantly elevated troponin was associated with higher odds of the composite outcome (odds ratio 16.1, 95% confidence interval 3.6-72.4, P < 0.001). Higher American Society of Anesthesiologists class independently predicted the composite outcome and mortality, and longer length of stay was associated with cardiac events.
CONCLUSIONS: Preoperative hs-cTn elevation was independently associated with in-hospital cardiac events and mortality after hip fracture surgery. Troponin levels greater than 100 ng/L identified patients at highest risk, independent of surgical delay.
LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.