After major non-cardiac surgery in high-risk older adults, do you routinely check post-operative troponins to screen for myocardial injury?

I do not routinely check postoperative troponins on every older adult after major non-cardiac surgery, but I do use them selectively in patients who are at high risk for perioperative cardiovascular complications. My practice has evolved as our understanding of myocardial injury after non-cardiac surgery, or MINS, has grown.

Patients with advanced age, known coronary artery disease, heart failure, peripheral vascular disease, diabetes with end-organ disease, chronic kidney disease, elevated Revised Cardiac Risk Index scores, or those undergoing high-risk vascular or major abdominal procedures are the patients in whom I am most likely to obtain surveillance troponins during the first 48 to 72 hours after surgery.

The rationale is that most per...

I actually do routinely check, although I very well may be the only one in my hospital who does.

I routinely check postoperative troponins only in a specific population: patients undergoing high-risk surgery who are themselves at elevated cardiovascular risk. In general, I use a predicted MACE risk greater than 1%—the threshold classified as elevated risk. I occasionally broaden this to patients with multiple risk factors who underwent a major operation but whose estimated MACE risk falls just below 1%, although this approach is less clearly supported by recent AHA guidance.

It is helpful to place this practice in a broader context. Postoperative troponin surveillance has been used for much longer, and much more routinely, in other countries....