Postoperative visits by dedicated anesthesiologists in patients with elevated troponin: a retrospective cohort study evaluating postoperative care utility and early detection of complications

Table 3 Consultations, interventions, and causes of troponin elevation assigned by the dedicated anesthesiologist, dependent on the height of troponin elevation

	TnI 18–119 ng L⁻¹	TnI 120–599 ng L⁻¹	TnI ≥ 600 ng L⁻¹
N	543	192	76
Consultation (%)
No visit, advice only	28 (5.2)	4 (2.1)	3 (3.9)
Only 1-time visit	186 (34.3)	90 (46.9)	39 (51.3)
> 1 visit	88 (16.2)	49 (25.5)	22 (28.9)
Any diagnostics ordered (%)	207 (38.1)	126 (65.6)	48 (63.2)
ECG	201 (37.0)	120 (62.5)	47 (61.8)
Echocardiography	3 (0.6)	19 (9.9)	26 (34.2)
CT angiography	2 (0.4)	3 (1.6)	4 (5.3)
Additional troponin	76 (14.0)	61 (31.8)	38 (50.0)
Other enzymes (i.e., CK-MB)	23 (4.2)	43 (22.4)	36 (47.4)
Other specialty consulted (%)
Cardiology	39 (7.2)	65 (33.9)	51 (67.1)
Pulmonology	5 (0.9)	2 (1.0)	0 (0.0)
Other^a	6 (1.1)	2 (1.0)	0 (0.0)
Cardiology already involved (%)	57 (10.5)	46 (24.0)	21 (27.6)
Any change in treatment (%)	55 (10.1)	47 (24.5)	29 (38.2)
Change in medication	24 (4.4)	26 (13.5)	24 (31.6)
Red blood cell transfusion	6 (6.6)	28 (14.6)	14 (18.4)
Follow up at outpatient cardiac clinic (%)	73 (13.4)	64 (33.3)	50 (65.8)
Cause of myocardial injury (%)
Ischemic heart disease	6 (1.1)	12 (6.2)	28 (36.8)
Arrhythmia	22 (4.1)	8 (4.2)	0 (0.0)
Congestive heart failure	6 (1.1)	2 (1.0)	3 (3.9)
Pulmonary embolism	4 (0.7)	1 (0.5)	2 (2.6)
Pneumonia	7 (1.3)	4 (2.1)	0 (0.0)
Respiratory failure	11 (2.0)	9 (4.7)	1 (1.3)
Sepsis	9 (1.7)	6 (3.1)	2 (2.6)
Acute kidney injury	31 (5.7)	6 (3.1)	0 (0.0)
Anemia	15 (2.8)	8 (4.2)	4 (5.3)
Fluid overload	4 (0.7)	4 (2.1)	0 (0.0)
Hypertension	6 (1.1)	3 (1.6)	0 (0.0)
Perioperative hemodynamics^b	66 (12.2)	37 (19.3)	9 (11.8)
Other^c	15 (2.8)	8 (4.2)	3 (3.9)
Cause unknown	341 (62.8)	84 (43.8)	24 (31.6)

Troponin thresholds were chosen based on the thresholds as defined in the local protocol of the University Medical Center Utrecht (TnI 18–119 ng L⁻¹, TnI 120–599 ng L⁻¹, and TnI ≥ 600 ng L⁻¹)
^aIncluding nephrologist, hematologist, cardiothoracic surgeon, and geriatrician
^bIncluding hypotension and tachycardia
^cIncluding pericarditis, myocardial contusion, neurological conditions (e.g., subarachnoid hemorrhage), and fever
ECG electrocardiogram, CT computed tomography, CK-MB creatine-kinase isoenzyme, MCU surgical medium care unit, PACU post anesthesia care unit, TnI troponin I

ISSN: 2047-0525