DOES AN ELEVATED TROPONIN LEVEL ON ADMISSION AFFECT THE OUTCOME OF A PATIENT WITH AN OPERATIVELY TREATED FRAGILITY FRACTURE?

Surgical fixation of fragility fractures is a standard operation performed by Orthopaedics. It is recommended to operate on fragility fractures within 24 hours of admission due to increased postoperative complications with delays exceeding this guideline. However, many patients often have comorbidities, such as heart disease, that must be cleared preoperatively. Troponin levels are often used to evaluate this cardiac risk factor. If elevated, standard practice is to delay surgical fixation until levels return to a stable state. However, previous studies have found that earlier fixation of fragility fractures, regardless of elevated troponin levels, results in better outcomes. Thus, further research needs to be done regarding troponin levels, surgical delay, and outcomes in order to improve the postoperative surgical outcome of fragility fractures. A retrospective chart review was conducted. Patients were screened to include all individuals ≥ 50 years old that underwent surgical fixation of a fragility fracture of the lower extremity and had troponin levels measured prior to surgery. Age, sex, height, weight, BMI, fracture location, surgical procedure performed, time from initial ED triage to surgery, blood loss, troponin levels, length of initial hospital stay, history of MI, history of CHF, if an echocardiogram was ordered prior to surgery, and complications up to 90 days postop were collected. Patients were categorized into an elevated troponin group (≥0.06ng/mL) or a normal troponin group. A second categorization of those who regained total preoperative functional level (“success”) or those who had morbidity, readmission, or mortality within 90 days postoperatively (“complicated”) was done. Fisher exact test, Mann Whitney U test, and logistic regression were used to analyze categorical variables, continuous variables, and odd ratios respectively with a p<0.05 seen as significant. The study included 158 patients, with 27 patients in the elevated troponin group and 131 patients in the normal troponin group. The elevated troponin group had a significantly longer hospital stay (P<0.001) and a higher Charlson Comorbidity Index (P=0.044) and were more likely to have a history of CHF (P=0.036) and an echocardiogram ordered before surgery (P=0.003). The normal troponin group had a success rate of 68.7%, while the elevated troponin group had a 37.04% success rate (P=0.01). In the second categorization there were 100 patients in the success group and 58 patients in the complicated group. The time to surgery (P=0.007) and troponin levels (P=0.004) were significantly higher in the complicated group. Lastly, patients that had an elevated troponin as well as a delay in surgery > 24 hours were 186% more likely to have a complicated outcome (OR = .14, P<0.001). In conclusion, a delay in surgical fixation in patients with fragility fractures and elevated troponin levels poses an increased risk for complications and poor outcomes after surgery. However, operating within 24 hours of admission does not pose the same risk regardless of elevated or normal troponin levels. This conclusion supports previous studies' findings regarding a delay in surgery in patients with elevated troponin causing increased mortality compared to those with elevated troponin who underwent faster surgical fixation.