Perioperative Myocardial Injury

This single-center, retrospective cohort study evaluates whether a single preoperative peripheral nerve block can reduce the risk of perioperative myocardial injury in elderly patients undergoing delayed hip fracture surgery, defined as surgery performed more than 48 hours after injury. Hip fracture is a serious and common injury in older adults worldwide. When surgery cannot be performed within the recommended 48-hour window, patients face a much higher risk of heart muscle damage (myocardial injury), which is strongly linked to increased complications and death. Peripheral nerve blocks are a standard, safe method for pain control in hip fracture care, but their potential protective effect on the heart has not been specifically studied in patients with delayed surgery. This study will review medical records of patients aged 65 years and older who received hip fracture surgery at Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, between January 1, 2019 and December 31, 2025, with time from injury to surgery longer than 48 hours. Patients who received a single peripheral nerve block before surgery will be compared with patients who did not receive any peripheral nerve block. The main measure of the study is the rate of myocardial injury during hospital stay, detected by elevated troponin levels in routine blood tests. The study will also examine new-onset myocardial injury within 72 hours after surgery, major heart-related adverse events and all-cause death within 30 days after surgery, length of hospital stay, and other common postoperative complications. Researchers will also explore whether the timing of nerve block placement and different block techniques have different heart-protective effects. The findings may provide evidence for a simple, safe and practical strategy to reduce heart complications in older hip fracture patients who cannot receive timely surgery, and help clinicians improve perioperative care for this high-risk population.

Limiting perioperative tachycardia (aiming for a heart rate \<90 beats per minute throughout the perioperative period) using the ultra-short acting beta-blocker landiolol in patients with cardiovascular risk factors undergoing major surgery might lower the incidence of perioperative myocardial injury. Feasibility of the intervention needs to be proven prior to conduction of a larger trial.

Myocardial injury during non-cardiac surgery (PMI) affects up to 16% of high-risk patients and represents a significant burden on healthcare systems. An acute myocardial infarction is defined by a dynamic increase in cardiac troponin (cTn) above the 99th percentile and is accompanied by clinical signs of myocardial ischemia. Myocardial injury, on the other hand, is characterized by an increase in cardiac troponin, but without meeting the diagnostic criteria for myocardial infarction. In the perioperative interval, however, it is irrelevant whether a myocardial infarction according to the universal definition or merely an increase in troponin is present, as there is no difference in mortality between the two patient groups. The comprehensive study by Botto et al. provides valuable insights into the severity of MINS and found that 8.0% of patients met the diagnostic criteria. An important finding of this study is that the majority of MINS cases (87.1%) occurred within the first two days after surgery, highlighting the immediate risk of the condition (Botto et al., 2014). We would like to emphasize the necessity of our prospective, multicenter observational study by highlighting anesthesia-dependent variables such as hemodynamics, type of medication, their potential role, and surgical aspects such as duration of surgery, which represent risk factors for MINS. Identifying and understanding modifiable and non-modifiable risk factors is essential for targeted preoperative intervention. Understanding these factors is crucial for subsequent interventional studies and can also provide criteria for increased monitoring of high-risk patients, as suggested in the current guidelines.

The goal of this observational prospective cohort study is to learn about the pathophysiology of perioperative myocardial infarction/injury in high-risk patients undergoing major non-cardiac surgery. Participants will: * Wear wearable device (Basler Band) for up to seven days after the operation or until hospital discharge * Provide three blood samples. A venous specimen of blood (25 mL) will be collected preoperatively and on postoperative days 1 and 2. * Be contacted to answer a questionnaire one year after the surgery.