Abstract
Objective
To determine the clinical significance of tachycardia in the postoperative period.
Patients and Methods
Individuals 18 years or older undergoing hip and knee arthroplasty were included in
the study. Two data sets were collected from different time periods: development data
set from January 1, 2011, through December 31, 2011, and validation data set from
December 1, 2012, through September 1, 2014. We used the development data set to identify
the optimal definition of tachycardia with the strongest association with the vascular
composite outcome (pulmonary embolism and myocardial necrosis and infarction). The
predictive value of this definition was assessed in the validation data set for each
outcome of interest, pulmonary embolism, myocardial necrosis and infarction, and infection
using multiple logistic regression to control for known risk factors.
Results
In 1755 patients in the development data set, a maximum heart rate (HR) greater than
110 beats/min was found to be the best cutoff as a correlate of the composite vascular
outcome. Of the 4621 patients who underwent arthroplasty in the validation data set,
40 (0.9%) had pulmonary embolism. The maximum HR greater than 110 beats/min had an
odds ratio (OR) of 9.39 (95% CI, 4.67-18.87; sensitivity, 72.5%; specificity, 78.0%;
positive predictive value, 2.8%; negative predictive value, 99.7%) for pulmonary embolism.
Ninety-seven patients (2.1%) had myocardial necrosis (elevated troponin). The maximum
HR greater than 110 beats/min had an OR of 4.71 (95% CI, 3.06-7.24; sensitivity, 47.4%;
specificity, 78.1%; positive predictive value, 4.4%; negative predictive value, 98.6%)
for this outcome. Thirteen (.3%) patients had myocardial infarction according to our
predetermined definition, and the maximum HR greater than 110 beats/min had an OR
of 1.72 (95% CI, 0.47-6.27).
Conclusion
Postoperative tachycardia within the first 4 days of surgery should not be dismissed
as a postoperative variation in HR, but may precede clinically significant adverse
outcomes.
Abbreviations and Acronyms:
DVT (deep venous thrombosis), EHR (electronic health record), HR (heart rate), ICD-9 (International Classification of Diseases, Ninth Revision), MI (myocardial infarction), NPV (negative predictive value), OR (odds ratio), PE (pulmonary embolism), PPV (positive predictive value), SSI (surgical site infection), TJA (total joint arthroplasty), UTI (urinary tract infection)To read this article in full you will need to make a payment
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Article Info
Publication History
Published online: November 24, 2016
Footnotes
Grant Support: The work was supported by the Clinical and Translational Science Institute, NYU Langone Medical Center.
Identification
Copyright
© 2016 Mayo Foundation for Medical Education and Research
