• Alparslan Turan, Steve Leung, Gausan Ratna Bajracharya, Rovnat Babazade, Theresa Barnes, Yehoshua Nadav Schacham, Guangmei Mao, Nicole Zimmerman, Kurt Ruetzler, Kamal Maheshwari, Esa Wael Ali Sakr WAS From the Department of Outcomes Research. Department of General Anesthesia, Anesth, and Daniel I Sessler.
• From the Department of Outcomes Research.
• Anesth. Analg. 2020 Sep 1; 131 (3): 822-829.

BackgroundUncontrolled pain after noncardiac surgery activates the sympathetic nervous system, which causes tachycardia, hypertension, and increased cardiac contractility-all of which may increase myocardial oxygen demand. We therefore determined whether time-weighted average pain scores over the initial 72 postoperative hours are associated with myocardial injury after noncardiac surgery (MINS).MethodsWe conducted a retrospective cohort analysis of adults with routine postoperative troponin monitoring after noncardiac surgery under general, regional, or combined anesthesia at tertiary level centers in Cleveland from January 2012 to December 2015. Time-weighted average pain scores were calculated from all the available pain scores, typically at 4-hour intervals, until a troponin elevation was detected. MINS was defined as peak troponin T concentrations exceeding 0.03 ng/mL within 72 hours after surgery. We used a generalized linear mixed model to assess the association between pain and MINS with 3 hospitals as clusters, adjusting for potential confounders.ResultsAmong 2892 eligible patients, 4.5% had myocardial injury within 72 hours after surgery. Higher time-weighted average pain scores were associated with increased hazard of myocardial injury. The estimated hazard ratio for a 1-unit increase in pain score was 1.12 (95% confidence interval [CI], 1.02-1.22; P = .013), adjusting for confounding variables.ConclusionsAmong patients undergoing noncardiac surgery, time-weighted average pain scores within 72 hours after surgery were significantly associated with myocardial injury.

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