Effect of a national guideline on postoperative troponin surveillance: a retrospective cohort study

PurposeWe aimed to evaluate the effect of the 2017 Canadian Cardiovascular Society (CCS) guidelines on troponin surveillance after noncardiac surgery.MethodsThis was a single-centre, retrospective, observational study. Patients aged 40 yr or older undergoing intermediate- to high-risk elective noncardiac surgery between 2016 and 2021 were included. We compared the number and percentage of troponin tests ordered before and after the guidelines were published and compared patient characteristics, specifically cardiovascular comorbidity, using odds ratio's (OR) with 95% confidence intervals (CIs). Outcomes were myocardial injury, myocardial infarction (MI), and in-hospital mortality.ResultsThe cohort included 36,386 patients and the median age was 63 yr. Between 2016 and 2018, troponin surveillance was done in 2,461 (13%) of the 19,046 patients, compared with 2,398 (14%) of the 17,340 patients who had surgery between 2019 and 2021 (OR, 1.08; 95% CI, 1.02 to 1.15). Patients who had surgery in the second period had less cardiovascular comorbidity; the adjusted OR for troponin surveillance was 1.14 (95% CI, 1.07 to 1.21). In the two periods, troponin was elevated in 561 (2.9%) and 470 (2.7%) patients, an MI was documented in 54 (0.3%) and 36 (0.2%) patients, and 95 (0.5%) and 73 (0.4%) patients died, respectively. After adjustment for baseline differences in the two periods, the ORs for MI and mortality were 0.83 (95% CI, 0.54 to 1.27) and 0.88 (95% CI, 0.64 to 1.19), respectively.ConclusionAlthough the odds of troponin ordering were slightly but significantly higher after publication of the CCS guidelines, the odds for detecting an MI and for mortality did not change. ObjectifNotre objectif etait d'evaluer l'effet des lignes directrices 2017 de la Societe canadienne de cardiologie (SCC) sur le monitorage de la troponine apres une chirurgie non cardiaque.MethodeIl s'agissait d'une etude observationnelle retrospective monocentrique. Les patient center dot es age center dot es de 40 ans ou plus beneficiant d'une chirurgie non cardiaque non urgente a risque intermediaire a eleve entre 2016 et 2021 ont ete inclus center dot es. Nous avons compare le nombre et le pourcentage de tests de troponine prescrits avant et apres la publication des lignes directrices et compare les caracteristiques des patient center dot es, en particulier la comorbidite cardiovasculaire, en utilisant le rapport de cotes (RC) avec des intervalles de confiance (IC) a 95 %. Les criteres d'evaluation comprenaient les lesions myocardiques, l'infarctus du myocarde (IM) et la mortalite hospitaliere.ResultatsLa cohorte comprenait 36 386 personnes et l'age median etait de 63 ans. Entre 2016 et 2018, le monitorage de la troponine a ete realise chez 2461 (13 %) des 19 046 patient center dot es, contre 2398 (14 %) des 17 340 patient center dot es opere center dot es entre 2019 et 2021 (RC, 1,08; IC 95%, 1,02 a 1,15). Les patient center dot es qui ont beneficie d'une intervention chirurgicale au cours de la deuxieme periode presentaient moins de comorbidite cardiovasculaire; le RC ajuste pour le monitorage de la troponine etait de 1,14 (IC 95 %, 1,07 a 1,21). Au cours des deux periodes, la troponine etait elevee chez 561 (2,9 %) et 470 (2,7 %) patient center dot es, un IM a ete documente chez 54 (0,3 %) et 36 (0,2 %) patient center dot es, et 95 (0,5 %) et 73 (0,4 %) patient center dot es sont decede center dot es, respectivement. Apres ajustement pour tenir compte des differences initiales au cours des deux periodes, les RC pour l'IM et la mortalite etaient de 0,83 (IC 95 %, 0,54 a 1,27) et de 0,88 (IC 95 %, 0,64 a 1,19), respectivement.ConclusionBien que les probabilites de commande de troponine aient ete legerement mais significativement plus elevees apres la publication des lignes directrices de la SCC, les probabilites de detection d'un IM et de mortalite n'ont pas change.