TY - JOUR

T1 - Association between tissue oxygenation and myocardial injury in patients undergoing major spine surgery

T2 - A prospective cohort study

AU - Bernholm, Katrine Feldballe

AU - Meyhoff, Christian S.

AU - Bickler, Philip

N1 - Publisher Copyright: © Author(s) (or their employer(s)) 2021.

PY - 2021

Y1 - 2021

N2 - Objective To describe the association between intraoperative tissue oxygenation and postoperative troponin elevation in patients undergoing major spine surgery. We hypothesised that a decrease in intraoperative skeletal muscle tissue oxygenation (SmO2) was associated with the peak postoperative cardiac troponin value. Design This is a prospective cohort study. Setting Single-centre, University of California San Francisco Medical Center. Participants Seventy adult patients undergoing major elective spine surgery. Primary and secondary outcome measures High-sensitivity troponin T (hsTnT) was measured in plasma preoperatively and on the first and second day after surgery to assess the primary outcome of peak postoperative hsTnT. Secondary outcomes included MINS and intensive care unit (ICU) admission within 30 days. Skeletal cerebral tissue oxygenation and SmO2 was measured continuously with near-infrared spectroscopy during surgery. The primary exposure variable was time-weighted area under the curve (TW AUC) for SmO2. Results Mean age was 65 (33-85) years and 59% were female. No significant association was found between TW AUC for SmO2 and peak hsTnT (Spearman's correlation, rs =0.17, p=0.16). A total of 28 (40%) patients had MINS. ICU admission occurred in 14 (40%) in lower vs 25 (71%) in upper half of patients based on TW AUC for SmO2, p=0.008. Conclusions Decrease in SmO2 was not a statistically significant predictor for peak troponin value following major spine surgery but is a potential predictor for other postoperative complications.

AB - Objective To describe the association between intraoperative tissue oxygenation and postoperative troponin elevation in patients undergoing major spine surgery. We hypothesised that a decrease in intraoperative skeletal muscle tissue oxygenation (SmO2) was associated with the peak postoperative cardiac troponin value. Design This is a prospective cohort study. Setting Single-centre, University of California San Francisco Medical Center. Participants Seventy adult patients undergoing major elective spine surgery. Primary and secondary outcome measures High-sensitivity troponin T (hsTnT) was measured in plasma preoperatively and on the first and second day after surgery to assess the primary outcome of peak postoperative hsTnT. Secondary outcomes included MINS and intensive care unit (ICU) admission within 30 days. Skeletal cerebral tissue oxygenation and SmO2 was measured continuously with near-infrared spectroscopy during surgery. The primary exposure variable was time-weighted area under the curve (TW AUC) for SmO2. Results Mean age was 65 (33-85) years and 59% were female. No significant association was found between TW AUC for SmO2 and peak hsTnT (Spearman's correlation, rs =0.17, p=0.16). A total of 28 (40%) patients had MINS. ICU admission occurred in 14 (40%) in lower vs 25 (71%) in upper half of patients based on TW AUC for SmO2, p=0.008. Conclusions Decrease in SmO2 was not a statistically significant predictor for peak troponin value following major spine surgery but is a potential predictor for other postoperative complications.

KW - Anaesthesia in orthopaedics

KW - Myocardial infarction

KW - Spine

U2 - 10.1136/bmjopen-2020-044342

DO - 10.1136/bmjopen-2020-044342

M3 - Journal article

C2 - 34535471

AN - SCOPUS:85115395669

VL - 11

JO - BMJ Open

JF - BMJ Open

SN - 2044-6055

IS - 9

M1 - e044342

ER -