SHM Converge Conference Coverage

Ischemic Events After Hip Fracture Surgery Associated With Poor Long-Term Outcomes

Miranda Manier, BA

Key Highlights

  • Myocardial injury after noncardiac surgery (MINS), perioperative myocardial injury (PMI), and postoperative myocardial infarction (postop-MI) are strongly associated with increased 1-year mortality following hip fracture surgery.
  • Patients with MINS had a 52.3% 1-year mortality rate vs 18.2% for those without MINS (P < .0001).
  • PMI and postop-MI were each associated with a 59.1% 1-year mortality, significantly higher than in patients without these events (P < .0001).
  • Findings support routine troponin surveillance post-hip fracture surgery for early identification of silent ischemic events.

Perioperative MINS, PMI, and postop-MI—were found to be significant predictors of long-term mortality among patients undergoing hip fracture surgery in a study presented at the Society of Hospital Medicine's SHM Converge 2025 between April 22-25, 2025, in Las Vegas, NV. These events were associated with increased 1- and 2-year mortality rates, suggesting a need for proactive surveillance and intervention in this population.

Hip fracture surgery is commonly associated with substantial postoperative cardiovascular complications, often occurring silently because of perioperative analgesia. Past studies have shown that myocardial injury, indicated by elevated troponin levels, correlates with increased short-term mortality. However, the long-term prognostic significance of ischemic events such as MINS, PMI, and postop-MI in this context remains inadequately characterized, necessitating further research.

This retrospective study reviewed the outcomes of 248 patients who underwent hip fracture repair between April 2016 and July 2021 at the University of Virginia. Definitions used included MINS (peak postoperative troponin T ≥ 0.03 ng/mL from an ischemic cause within 30 days), PMI (a troponin increase ≥ 0.03 ng/mL between pre- and post-op or in two consecutive post-op values), and postop-MI (troponin T ≥ 0.03 ng/mL with ischemic symptoms or diagnostic findings such as ECG changes, wall motion abnormalities, or coronary thrombosis). Chi-squared analyses were used to compare mortality between patients with and without these events.

Among the cohort, the 1- and 2-year mortality rates were 21% and 32%, respectively. MINS occurred in 16.9% (42/248) of patients, with a 1-year mortality rate of 52.3% compared with 18.2% among those without MINS (P < .0001). PMI occurred in 8.9% (22/248) of patients and was associated with a 1-year mortality of 59.1% vs 26.7% in patients without PMI (P < .0001). Similarly, postop-MI was observed in 8.9% (22/248) of patients, with a 1-year mortality of 59.1% compared to 31% in those without postop-MI (P < .0001).

“These data support the role of routine troponin surveillance for identifying myocardial injury after hip fracture surgery and the need for further research to elucidate risk modification strategies,” the study authors concluded.

Reference
Caruso JJ, Weiss D, Mazimba S, et al. Impact of perioperative myocardial ischemia on long-term outcomes after hip fracture surgery. Paper presented at: Society of Hospital Medicine's SHM Converge Conference 2025; April 22-25, 2025; Las Vegas, NV. Accessed April 22, 2025. https://shmconverge.hospitalmedicine.org/