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Troponin Elevation after Colorectal Surgery: Significance and Management
Billy Y Lan*, H. Hande Aydinli*, Grant W Reed*, Venu Menon*, Daniel I Sessler*, Feza H Remzi, Luca Stocchi*, Emre Gorgun*
Cleveland Clinic, Cleveland, OH

Objective: Myocardial infarction is the leading cause of death after noncardiac surgery. Patients with asymptomatic troponin elevations have the same early mortality as symptomatic infarctions. The purpose of this study is to identify the association between early postoperative troponin elevations and outcomes after major colorectal surgery.
Methods: All patients over age 45 undergoing colorectal surgery from March to August 2015 at a single, tertiary institution were identified. Data was collected through the institutional review board-approved Outcomes Research Database. Patients having general anesthesia for major abdominal colorectal operations were included. Plasma troponin T concentrations were prospectively collected within 24 and 48 hours after surgery. Management and outcomes of patients with elevated troponin concentrations were evaluated.
Results: A total of 532 patients were screened with postoperative troponin concentrations (Figure 1). None of the 16 patients with troponin concentration >0.03ng/mL exhibited typical symptoms of myocardial ischemia. Cardiology was consulted for 10 patients with troponin >0.03ng/mL and medical therapy started. An echocardiogram was obtained in 8 of these patients. Three patients who died within the follow-up period had troponin concentrations greater than 0.03ng/mL.
Conclusions: Most postoperative myocardial infarctions are asymptomatic and may only be detected by routine troponin screening. Patients with elevated troponin concentrations after colorectal surgery are at higher risk of morbidity and mortality. Routine screening of troponin levels may prompt testing and intervention in select patients.


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