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Postoperative Tachycardia

Clinically Meaningful or Benign Consequence of Orthopedic Surgery?
Published:November 24, 2016DOI:https://doi.org/10.1016/j.mayocp.2016.08.005

      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)
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