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Postoperative visits by dedicated anesthesiologists in patients with elevated troponin: a retrospective cohort study evaluating postoperative care utility and early detection of complications
Lisette M. Vernooij
Universitair Medisch Centrum Utrecht
Corresponding Author
ORCiD: https://orcid.org/0000-0002-9153-087X
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published version at Perioperative Medicine.
Background: An elevated cardiac troponin level after noncardiac surgery is associated with both morbidity and mortality. Guidelines suggest routine troponin monitoring in high-risk patients. We implemented a dedicated anesthesia team to conduct follow-up on patients with postoperative troponin elevation. We hypothesized that these visits would facilitate early detection of complications. Therefore, the aim of this study was to evaluate the effect of postoperative visits by dedicated anesthesiologists on early detection of complications and care utility.
Methods: This retrospective observational study included patients aged ³60 years with an elevated troponin within the first three days after noncardiac surgery. Troponin elevation was detected by routine biomarker monitoring. The primary outcome was early detected myocardial infarctions by the dedicated anesthesiologist. Other outcomes were overall detected complications, additional diagnostic tests and treatment advised by the anesthesiologist, consultation of another medical specialist, and advised postoperative follow-up at the outpatient cardiac clinic within one week after surgery.
Results: Of the 811 patients, 509 (63%) received a postoperative consultation by the anesthesiologist. Anesthesiologists were involved in the early detection of 59% of all myocardial infarctions and in 12% of all complications. Besides cardiac ischemia, patients were also often diagnosed with noncardiac complications, including respiratory failure (8.9%), pneumonia (13.2%) and acute kidney injury (17.5%) within one week after surgery. In 75% of patients, anesthesiologists ordered additional diagnostics, most frequently existing of electrocardiograms and additional cardiac enzyme testing. Additionally, change in treatment was advised, most often a medication change, in 16% of patients.
Conclusions: Standard consultation of a dedicated anesthesiologist resulted in an early detection of 59% of all myocardial infarctions and involved a change in treatment in a considerable number of patients with postoperative troponin elevation. Whether this may improve patient outcomes remains to be elucidated.
Keywords
troponin, perioperative anesthesiologist, screening, myocardial infarction
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CURRENT STATUS: Published
Version 2
Posted 15 Apr, 2020
Published
On 16 Jul, 2020
No community comments so far
Editorial decision: Accept
On 01 May, 2020
Review #1 received
Received 26 Apr, 2020
Reviewer #1 agreed
On 15 Apr, 2020
Editor assigned
On 13 Apr, 2020
Reviewers invited
Invitations sent on 13 Apr, 2020
Submission checks complete
On 12 Apr, 2020
Editor invited
On 12 Apr, 2020
No comments provided
Reviewer #2 agreed
On 14 Mar, 2020
Review #2 received
Received 14 Mar, 2020
Editorial decision: Minor revision
On 14 Mar, 2020
Review #1 received
Received 01 Mar, 2020
Reviewer #1 agreed
On 09 Feb, 2020
Reviewers invited
Invitations sent on 08 Jan, 2020
Editor assigned
On 06 Jan, 2020
Submission checks complete
On 05 Jan, 2020
Editor invited
On 05 Jan, 2020
First submitted
On 03 Jan, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Anesthesiology & Pain Medicine
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This preprint is under consideration at Perioperative Medicine. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research
Postoperative visits by dedicated anesthesiologists in patients with elevated troponin: a retrospective cohort study evaluating postoperative care utility and early detection of complications
Lisette M. Vernooij
Universitair Medisch Centrum Utrecht
Corresponding Author
ORCiD: https://orcid.org/0000-0002-9153-087X
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
Version 2
Posted 15 Apr, 2020
Published
On 16 Jul, 2020
No community comments so far
Editorial decision: Accept
On 01 May, 2020
Review #1 received
Received 26 Apr, 2020
Reviewer #1 agreed
On 15 Apr, 2020
Editor assigned
On 13 Apr, 2020
Reviewers invited
Invitations sent on 13 Apr, 2020
Submission checks complete
On 12 Apr, 2020
Editor invited
On 12 Apr, 2020
No comments provided
Reviewer #2 agreed
On 14 Mar, 2020
Review #2 received
Received 14 Mar, 2020
Editorial decision: Minor revision
On 14 Mar, 2020
Review #1 received
Received 01 Mar, 2020
Reviewer #1 agreed
On 09 Feb, 2020
Reviewers invited
Invitations sent on 08 Jan, 2020
Editor assigned
On 06 Jan, 2020
Submission checks complete
On 05 Jan, 2020
Editor invited
On 05 Jan, 2020
First submitted
On 03 Jan, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Anesthesiology & Pain Medicine
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published version at Perioperative Medicine.
Background: An elevated cardiac troponin level after noncardiac surgery is associated with both morbidity and mortality. Guidelines suggest routine troponin monitoring in high-risk patients. We implemented a dedicated anesthesia team to conduct follow-up on patients with postoperative troponin elevation. We hypothesized that these visits would facilitate early detection of complications. Therefore, the aim of this study was to evaluate the effect of postoperative visits by dedicated anesthesiologists on early detection of complications and care utility.
Methods: This retrospective observational study included patients aged ³60 years with an elevated troponin within the first three days after noncardiac surgery. Troponin elevation was detected by routine biomarker monitoring. The primary outcome was early detected myocardial infarctions by the dedicated anesthesiologist. Other outcomes were overall detected complications, additional diagnostic tests and treatment advised by the anesthesiologist, consultation of another medical specialist, and advised postoperative follow-up at the outpatient cardiac clinic within one week after surgery.
Results: Of the 811 patients, 509 (63%) received a postoperative consultation by the anesthesiologist. Anesthesiologists were involved in the early detection of 59% of all myocardial infarctions and in 12% of all complications. Besides cardiac ischemia, patients were also often diagnosed with noncardiac complications, including respiratory failure (8.9%), pneumonia (13.2%) and acute kidney injury (17.5%) within one week after surgery. In 75% of patients, anesthesiologists ordered additional diagnostics, most frequently existing of electrocardiograms and additional cardiac enzyme testing. Additionally, change in treatment was advised, most often a medication change, in 16% of patients.
Conclusions: Standard consultation of a dedicated anesthesiologist resulted in an early detection of 59% of all myocardial infarctions and involved a change in treatment in a considerable number of patients with postoperative troponin elevation. Whether this may improve patient outcomes remains to be elucidated.
Figure 1