Preoperative High-Sensitivity Troponin and Risk of In-Hospital Mortality and Cardiac Events after Hip Fracture Surgery

OBJECTIVES: To evaluate whether preoperative hs-cTn elevation predicted in-hospital cardiac events and mortality following hip fracture surgery, and whether surgical delay modified this relationship. DESIGN: Retrospective cohort study. SETTING: Single Level 1 trauma center in the United States. PATIENT SELECTION CRITERIA: Adult patients who underwent hip fracture surgery between January 1, 2020, and December 31, 2024, and had a preoperative high-sensitivity cardiac troponin measurement as part of routine perioperative assessment were included. OUTCOME MEASURES AND COMPARISONS: The primary outcome was a composite of in-hospital cardiac event or mortality. Secondary outcomes were in-hospital mortality and in-hospital cardiac events analyzed separately. Outcomes were compared across preoperative troponin categories defined as normal (<30 ng/L), elevated (30-100 ng/L), and significantly elevated (>100 ng/L), as well as across surgical delay categories defined as <24 hours, 24-48 hours, and >48 hours. RESULTS: A total of 510 patients were included. Mean age was 76.3 ± 14.1 years, and 291 patients (57.1%) were female. Preoperative troponin was normal in 424 patients (83.1%), elevated in 58 patients (11.4%), and significantly elevated in 28 patients (5.5%). Thirty-five patients (6.9%) experienced the composite outcome. The composite outcome occurred in 19 of 424 patients (4.5%) with normal troponin, 6 of 58 patients (10.3%) with elevated troponin, and 10 of 28 patients (35.7%) with significantly elevated troponin (p < 0.001). Mortality occurred in 8 of 424 patients (1.9%), 2 of 58 patients (3.4%), and 3 of 28 patients (10.7%), respectively (p = 0.015). Cardiac events occurred in 13 of 424 patients (3.1%), 4 of 58 patients (6.9%), and 9 of 28 patients (32.1%), respectively (p < 0.001). In adjusted models, elevated high-sensitivity cardiac troponin was associated with increased odds of the composite outcome (odds ratio [OR] 4.4, 95% confidence interval [CI] 1.1-17.9, p = 0.038), and significantly elevated troponin was associated with higher odds of the composite outcome (OR 16.1, 95% CI 3.6-72.4, p < 0.001). Higher American Society of Anesthesiologists class independently predicted the composite outcome and mortality, and longer length of stay was associated with cardiac events. CONCLUSIONS: Preoperative high-sensitivity cardiac troponin elevation was independently associated with in-hospital cardiac events and mortality after hip fracture surgery. Troponin levels greater than 100 ng/L identified patients at highest risk, independent of surgical delay. LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.