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Everyone knows that there are risks associated with any surgery. But the risks that you know about are the obvious ones.
Problems with the anesthesia such as aspiration pneumonitis or respiratory failure. Problems with the surgery itself such as excessive blood loss, damaging the spinal cord or spinal nerves, infection or blood clots.
But what if there was something more insidious that can occur? Something that won’t kill you today or tomorrow, but waits in the shadows until years later?
Before I tell you what this scary thing is, I do need to point out that there is a time and a place for orthopedic surgery. But this should only be considered as an absolute last option. All too often we THINK something is a last option.
But time and time again research proves that this is just not true. Some examples:
- More people are having knee replacements, but NOT because of more arthritis
- Most people with a torn knee meniscus will not need surgery
- Arthritis of the spine is not directly related to pain and should NOT be a reason for surgery
- After one year, sciatic patients who have no surgery fare no better than those who do
- Chronic low back pain patients who had fusion fare no better than those who don’t
This list is much longer, but you get the idea. There are an uncountable number of orthopedic surgeries done every year that were unnecessary. Which would be fine if there weren’t dangerous risks associated with orthopedic surgery and the chance that you will be no better after the surgery, or worse, in more pain after the surgery.
Side note–these comments do not apply to trauma-induced orthopedic surgeries–in these cases there are usually no options for avoiding an emergency surgery after trauma.
All of this brings me to this particular study. In it, researchers looked at a scary side effect of orthopedic surgery called myocardial necrosis. As you may be able to tell from the name, this is a condition were the heart muscle dies as a result of the stress on the heart from the surgery. This bad effect from surgery is well known and characterized for short term mortality after orthopedic surgery.
What is not as well-known is what happens in the long term. To get a better idea of how often this happens, researchers looked at levels of troponin (a protein found in the heart; elevated troponin levels are a sign that damage to the heart has occurred) immediately after orthopedic surgery and whether this related to long term death in hip, knee, and spine surgery 3 years later. Here’s the details:
- There were 3,050 surgeries with an average age of 60.8 years.
- Myocardial necrosis occurred in 179 cases (5.9%) and heart attacks in 20 (0.7%).
- In those patient who experienced myocardial necrosis, 16.8% of them did not survive in the long term (3 years).
- In those who had normal troponin levels around the time of surgery only 5.8% did not survive.
- To put it clearer, those orthopedic surgery patients who had higher levels of troponin were 233% more likely to die in the long term evaluation, while those who had a heart attack after the surgerys were 351% more likely to die.
Now certainly, if you had a heart attack just after your orthopedic surgery you’d know about it. But myocardial necrosis may not have been fully explained to you if it had been identified. Either way, if you DO end up having orthopedic surgery, it may makes sense to push your surgeon to run troponin levels along with everything else to get an idea about whether or not you’re going to be around in the next 3 years.
Seems simple enough.