From the Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
ICES, Toronto, Ontario, Canada.
Anesth Analg. 2023 Sep 1;137(3):629-637. doi: 10.1213/ANE.0000000000006411. Epub 2023 Mar 8.
Acute myocardial injury after noncardiac surgery, which is most often symptomatically silent, is associated with increased mortality and morbidity. However, it is not known if routine postoperative troponin testing will affect patient outcomes.
We assembled a cohort of patients who underwent carotid endarterectomy or abdominal aortic aneurysm repair in Ontario, Canada, from 2010 to 2017. Hospitals were categorized into high, medium, and low troponin testing intensity based on the proportion of patients who received postoperative troponin testing. Cox proportional hazards modeling was used to assess the association between hospital-specific testing intensity and 30-day and 1-year major adverse cardiovascular events (MACEs) while adjusting for patient-, surgery-, and hospital-level factors.
The cohort consisted of 18,467 patients from 17 hospitals. Mean age was 72 years, and 74.0% were men. Rates of postoperative troponin testing were 77.5%, 35.8%, and 21.6% in the high-, medium-, and low-testing intensity hospitals, respectively. At 30 days, 5.3%, 5.3%, and 6.5% of patients in high-, medium-, and low-testing intensity hospitals experienced MACE, respectively. Higher troponin testing rate was associated with lower adjusted hazard ratios (HRs) for MACE at 30 days (0.94; 95% confidence interval [CI], 0.89-0.98) and at 1 year (0.97; 95% CI, 0.94-0.99) for each 10% increase in hospital troponin rate. Hospitals with high-testing intensity had higher rates of postoperative cardiology referrals, cardiovascular testing, and rates of new cardiovascular prescriptions.
Patients undergoing vascular surgery at hospitals with higher postoperative troponin testing intensity experienced fewer adverse outcomes than patients who had surgery at hospitals with lower testing intensity.
非心脏手术后发生的急性心肌损伤，通常无症状，但与死亡率和发病率增加有关。然而，尚不清楚常规术后肌钙蛋白检测是否会影响患者的结局。
我们组建了一个 2010 年至 2017 年在加拿大安大略省接受颈动脉内膜切除术或腹主动脉瘤修复的患者队列。根据接受术后肌钙蛋白检测的患者比例，将医院分为高、中、低肌钙蛋白检测强度。采用 Cox 比例风险模型评估医院特定检测强度与 30 天和 1 年主要不良心血管事件（MACE）之间的关系，同时调整患者、手术和医院水平的因素。
队列包括来自 17 家医院的 18467 名患者。平均年龄为 72 岁，74.0%为男性。高、中、低检测强度医院的术后肌钙蛋白检测率分别为 77.5%、35.8%和 21.6%。在 30 天时，高、中、低检测强度医院分别有 5.3%、5.3%和 6.5%的患者发生 MACE。肌钙蛋白检测率越高，调整后的 30 天（0.94；95%置信区间[CI]，0.89-0.98）和 1 年（0.97；95%CI，0.94-0.99）MACE 调整后风险比（HR）越低。肌钙蛋白检测率较高的医院术后心脏病学转诊、心血管检查和新的心血管处方率更高。
在术后肌钙蛋白检测强度较高的医院接受血管手术的患者比在检测强度较低的医院接受手术的患者发生不良结局的风险更低。
