Risk Factors for Perioperative Myocardial Infarction/Injury and Mortality Following Surgical Treatment of Proximal Femur Fractures: A Cohort Study.

Abstract

This study aimed to investigate the incidence of perioperative myocardial infarction/injury (PMI) and mortality and to identify associated risk factors, in patients undergoing surgical treatment for proximal femur fractures (PFFs). We performed a post hoc analysis of a prospective cohort study and included consecutive patients undergoing surgery for PFFs (femoral neck, intertrochanteric, or subtrochanteric fractures) at a tertiary center between 2014 and 2018. All patients underwent systematic PMI screening using serial high-sensitivity cardiac troponin T measurements. The primary outcomes were incidence of PMI and all-cause mortality at 1 year. Univariable logistic regression identified risk factors for PMI and mortality. Among 348 patients, 23% developed PMI. PMI incidence did not differ significantly between arthroplasty and osteosynthesis groups (22.0% vs. 24.0%, p = 0.7). A history of myocardial infarction and hypertension was associated with increased PMI risk. One-year mortality was 17.8% overall and higher in patients with PMI compared with those without (27.5% vs. 14.9%, p = 0.013). Significant risk factors for 1-year mortality included low body mass index, history of atrial fibrillation, low preoperative hemoglobin, and higher anesthesiologists class. No associations were found between PMI or mortality and fracture type, implant type, use of bone cement, or anesthesia type. PMI is common after surgical treatment of PFFs and is associated with increased mortality. Systematic screening improves detection, enabling optimization of perioperative management. We recommend routine PMI screening in high-risk patients undergoing PFF surgery to reduce adverse outcomes. Level II. See Instructions for Authors for a complete description of levels of evidence.