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POST-OPERATIVE TROPONIN-I, AS AN INDEPENDENT MORBIDITY MARKER AND PREDICTOR OF HOSPITAL STAY IN GASTROINTESTINAL SURGERIES
Keyur S. Bhatt*
HPB & GI Surgery, SIDS Hospital & Research Center, Surat, Gujarat, India

Introduction: Cardiac-specific Troponin -I (Trop -I) is a marker for myocardial injury, as it released from the myocardium. Many studies are stating elevated Trop -I following noncardiac surgery is a marker for early cardiac death following noncardiac surgery. However, we state the hypothesis of Trop-I levels acting as an independent marker for morbidity and hospital stay apart from cardiac mortality.
Methods: We did an observational prospective cohort study from June 2017 to Oct. 2019. During this period a total of 2800 patients were operated at our institute’s Gastro Surgery Department. Patients who were more than 45 years of age, with either Diabetes, Hypertension or IHD were included in the study and their Trop-I levels were measured following surgery. A total of 235 patients were included in the study, out of which 119 had Trop-I less than 19 ng/L (Our laboratory’s normal limit) and 116 had more than 19 ng/L. Demographic details, albumin level, total WBC count, preoperative cardiac status (EF%), ECG changes/post-operative cardiac function, morbidity, and mortality were recorded.
Results: We analyzed data and samples were compared between 2 groups, one with normal and other with elevated Trop-I levels postoperatively. Both groups were comparable in terms of the total number (119 vs 116), mean age in years (57 vs 62.5), Male (72 vs 75), female (47 vs 41), preoperative IHD (17 vs 22), preoperative diabetes mellitus (40 vs 42), hypertension (65 vs 51), preoperative EF of 40 to 60 % in (114 vs 113), preoperative S. albumin level (3.9 vs 3.2), Hemoglobin level (13.2 vs 12.9), total WBC count (11,800 vs 13,200). Upon analysis in general and gastro surgery, we found to have one mortality (0.84 %) in normal Trop-I group vs 12 (19.05 %) in elevated Trop-I group. Morbidity was 3.36 % vs 66.67 %. Data were further analyzed and compared according to the type of surgery for the length of hospital stay and ICU stay. For Minimally invasive surgery (MIS) group, mean hospital stay was 3.2 vs 6.8 days (P-value- <0.05), ICU stay was 0.9 days vs 3.4 days (P-value- <0.05). For luminal surgery group, hospital stay was 7.5 vs 10.5 days (P value-<0.05), ICU stay was 1.9 days vs 4.9 days (p-value <0.05), for complex laparotomy hospital stay 6.75 days vs 9.7 days (p-value-0.03), ICU stay was 3.75 vs 4.87 days (P-value-0.1), for hernia repairs hospital stay was 3.2 days vs 7.6 days (P-value -0.02), ICU stay was 0.36 days vs 4.6 days (P-value-0.04), for Hepatobiliary surgery hospital stay was 13 days vs 10.4 days (P-value-0.3), ICU stay was 4.8 days vs 5 days (P-value-0.36 ).
Conclusion:
In our small sample study, we could find out that Trop-I can act as an independent prognostic factor for cardiac-related mortality as well as a predictor of morbidity & hospital stay following noncardiac surgery. We recommend further large-scale studies to prove our hypothesis.


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