Peroperative in patients under neurosurgy operation the relationship of the variables with the postoperative troponin level and the mins

Objective: Myocardial injury after non-cardiac surgery (MINS) is a novel clinical concept, which is myocardial injury characterized by elevations in cardiac biomarkers during or within 30 days of surgery, with or without ischemic symptoms. The relationship of MINS with postoperative major cardiac events and mortality has been demonstrated by many studies. Contrary to this, studies and data on the incidence and risk factors in specific patient groups, such as patients undergoing neurosurgery operations, are limited. With this retrospective cohort study, it was aimed to determine the incidence of MINS and the perioperative associated risk factors in elderly patients undergoing intracranial surgery. Materials and Methods: Following the approval of the ethics committee of our faculty, patients who underwent elective intracranial surgery in the neurosurgery clinic of our hospital between 01/01/2015 and 01/01/2019 were screened. Among these patients, patients aged 65 years and over, followed up with high-sensitivity cardiac troponin T (hs-cTnT) for a minimum of 3 days post-operatively, and hospitalized in the neurosurgical intensive care unit for at least 1 day were included in the study. The data of the patients were obtained by retrospectively scanning the hospital information system, anesthesia slips and intensive care patient follow-up forms. Demographic data of the patients (gender, age, height, weight), comorbidities, drugs used, preoperative laboratory findings, regarding the intraoperative period; operation time, the first heart rate value measured before anesthesia induction, presence of serious bleeding (at least 1000 ml), intraoperative hypotension (MAP<60 mmHg for at least 30 seconds) and the use of vasopressors, postoperative hs-cTnT values measured at the 24th, 48th and 72nd hours and postoperative 30-day follow-up results were recorded. Results: 177 patients were included in our study, and the incidence of MINS, as the primary outcome, was found to be 36.2% (n=64). The patients were evaluated by dividing into two groups as MINS positive and MINS negative patients. The mean age of the patients included in our study was 68.94±9.30 years, while the mean age of the MINS positive and MINS negative groups were 72.80±7.07 and 66.76±9.72, respectively (p=0.001). 53.1% (n=94) of our patients were male and 46.9% (n=83) were female, and the incidence of MINS did not differ significantly between genders (p>0.05). Mortality rate was 2.8% (n=5), and all cases with mortality were within the MINS positive group (p=0.006). Coronary artery disease (p=0.04), atrial fibrillation (p=0.001), preoperative anticoagulant agent use (p=0.001), hypertension (p=0.046), intraoperative severe bleeding (p=0.003), and intraoperative vasopressor use (p=0.001) were found statistically significant in MINS development. Age and mortality rates of MINS-positive patients were statistically significantly higher than the MINS negative patients (p=0.001 and p=0.006, respectively). Conclusion: After intracranial operations, MINS is seen with considerable a frequency. Advanced age, discontinuation of the use of anticoagulant or antiplatelet drugs before the operation, intraoperative hypotension and use of vasopressors are the most important risk factors. Patients with myocardial injury showed a significant increase in 30-day mortality compared to patients without myocardial injury. Therefore, patients with MINS should be recognized and followed closely in the postoperative period. In addition, avoidance of the preventable risk factors (unnecessarily long periods of discontinuation of anticoagulant and antiplatelet drugs and intraoperative hypotension) will reduce the incidence of MINS and the associated mortality increase due to MINS.