Abstract

Even slight increases in preoperative troponin levels have been demonstrated to be associated with worse outcomes. On the other hand, there are currently insufficient data on the connection between an elevated troponin level and the appropriate time for surgery. Methods: We carried up a retrospective cohort analysis at a single institution on a total of 4575 patients, each of whom had a troponin measurement taken within the 30 days prior to undergoing a noncardiac surgical procedure. Subjects who had detectable levels of troponin were categorised into one of three terciles according to the magnitude of the value as well as the amount of time that had passed since this value before the surgery. Using bivariable and multivariable logistic regression, these 9 cohorts were compared with the group of patients whose preoperative troponin levels were undetectable. The comparison was made for those who were receiving non-emergency surgeries. Results: In the group whose levels of troponin could not be detected, the thirty-day death rate was 4.7%, but it rose steadily with increasing concentrations, reaching rates of 8.9%, 12.7%, and 12.7% in the low, medium, and high tercile groups, respectively. Those patients who had the highest troponin levels and the shortest delay between the measurement and surgery had the highest unadjusted risk of 30-day death (odds ratio: 4.497; 95% confidence interval: 2.058-9.825). After taking into account the characteristics of the subjects, the association between troponin and 30-day mortality maintained in several groups, even those composed of people whose troponin levels were within the normal range. Conclusions: Greater preoperative levels of cardiac troponin I were related with increased postoperative mortality, while persons with minor preoperative troponin increases who waited longer before undergoing surgery appeared to have a reduced risk of dying after surgery. There is a pressing need for prospective research to evaluate whether or not postponing surgery in individuals who have elevated preoperative troponin levels results in better postoperative outcomes.

Description