Association between tissue oxygenation and myocardial injury in patients undergoing major spine surgery: a prospective cohort study

Katrine Feldballe Bernholm, Christian S Meyhoff, Philip Bickler, Katrine Feldballe Bernholm, Christian S Meyhoff, Philip Bickler

Abstract

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.

Trial registration number: NCT03518372.

Keywords: anaesthesia in orthopaedics; myocardial infarction; spine.

Conflict of interest statement

Competing interests: CSM has received institutional direct and indirect research funding from Boehringer Ingelheim, Ferring Pharmaceuticals, Radiometer and Merch, Sharp & Dohme, as well as lecture fees from Radiometer, all outside submitted work. The remaining authors declare that they have no conflict of interest.

© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1
Figure 1
Relationship between time-weighted area under the curve (TW AUC) for skeletal muscle tissue oxygenation (SmO2) and peak value of high-sensitivity troponin T (hsTnT) measured within the first 2 days after surgery.
Figure 2
Figure 2
Adjusted prediction curve for time-weighted area under the curve (TW AUC) for skeletal muscle tissue oxygenation (SmO2) as predictor for myocardial injury after non-cardiac surgery (MINS).

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