Establishing and Exploring the Incidence of Myocardial Injury after Noncardiac Surgery among Orthopedic Patients in Western New York
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There is no baseline incidence of myocardial infarction after non-cardiac surgery (MINS) for orthopedic patients in Western New York (WNY). The specific aim of this study is to establish a baseline incidence of MINS in patients undergoing repair/revision/reconstruction of the femur/knee, shoulder, or hip/pelvis in the WNY area by analyzing insurance data. An insurance database was queried for any patient between 18 years and 89 years of age, having continuous insurance enrollment for at least three months after the procedure, having billed for at least one CPT code consistent with an orthopedic surgery in a single encounter within the last 5 years, and lived in zip codes within Niagara and Erie Counties. This subset was further queried for age, sex, home zip code (first 3 digits), year of procedure, ASA score, presence of emergency surgery identifier, and to see if an ICD 9 or 10 code consistent with an MI was present within 30 days of the procedure. A total of 12,678 cases were identified. The incidence of MI was 0.355 % across the entire cohort and 0.332%, 0.275%, 0.419% for femur/knee, shoulder, and hip/pelvis surgery respectively. Binary logistic regression using a stepwise selection technique was used to estimate the probability of an MI occurring within 30 days of the surgical procedure. Age emerged as the only significant predictor OR = 1.049, 95% CI [1.016, 1.083]. The methods used in this study can be used as a surveillance tool for MINS in multiple geographic areas and surgical populations.