Improvement of postoperative care decreases myocardial ischemia and major cardiac events

A study published in the October 2010 issue of Anesthesiology is among the first to show that the quality of immediate postoperative care of orthopedic surgery patients has important effects on patients' long-term cardiac outcomes.

According to lead study author Sylvain Ausset, M.D., from Percy Military Hospital in Clamart, France, the current "gold standard" for determining the impact of surgery on patients is to measure certain indicators months after surgery.

"Looking at long-term outcome, especially for mortality, is currently the gold standard for postoperative care, but it is difficult to obtain this end-point, and obviously needs a fair amount of time to occur," said Dr. Ausset. "What we sought was an indicator that would be quickly and easily available."

Over a three-year period, Dr. Ausset and his group measured troponin levels on the first three days after surgery in 378 orthopedic surgical patients to determine if there was any correlation between raised troponin levels and long-term cardiac outcomes.

Troponin is a protein that health care workers measure to determine whether physiologic stress related to a surgical procedure has caused damage to the heart. In the current study, Dr. Ausset concentrated on using troponin levels to detect myocardial ischemia (sometimes referred to as angina), the presence of which correlated with worse long-term cardiac outcomes.

Dr. Ausset and colleagues then modified postoperative care to reduce the occurrence of events that were thought to lead to increased episodes of myocardial ischemia based on raised troponin levels. Reducing the incidence of myocardial ischemia, then, was found to be an important step in lowering the incidence of cardiac problems months and even years later. According to Dr. Ausset, this is an important new concept that could be utilized in the immediate post-surgical care of orthopedic patients.

"An improvement of quality of postoperative care results in a two-fold decrease of postoperative myocardial ischemia and a four-fold decrease of major cardiac events later on," said Dr. Ausset.

Results Could Lead to New or Improved Clinical Guidelines

In a companion editorial on the study, Don Poldermans, M.D., Ph.D., of Erasmus Medical Center, Rotterdam, Netherlands, indicated that the results of Dr. Ausset's study could help to improve quality of care in orthopedic surgical patients by providing firm evidence for the development of clinical practice guidelines.

"Assessing quality of care is becoming more and more important in contemporary medical practice," said Dr. Poldermans. "Establishment of accurate and valid performance measures in noncardiac surgery is therefore highly recommended. This study's findings speak to the need for more initiatives that improve quality of care in patients undergoing noncardiac surgery."

Dr. Ausset and his group improved quality of care for their patients in simple but effective ways, said Dr. Poldermans. Such methods included tighter control of oxygen and glucose levels in the blood and engendering a consistency and continuity of care among the hospital staff team as they monitored and cared for patients.