Date of this Version

2021

Document Type

DNP Project

Abstract

Background: Myocardial injury after noncardiac surgery is considered a common perioperative complication associated with increased morbidity and mortality following surgery. Patients who sustain MINS are predominantly asymptomatic and do not meet the conventional definition and diagnostic criteria for myocardial infarction (MI). This presents a challenge in identifying patients with MINS without proper surveillance and monitoring in place.

Objectives: The purpose of this study is to improve anesthesia provider knowledge on the value of perioperative troponin monitoring in identifying myocardial injury after noncardiac surgery. A literature review including primary research studies addresses the PICO question: “In patients older than 45 years of age with cardiovascular risk factors, does routine perioperative troponin monitoring vs. monitoring traditional subjective symptoms indicative of postoperative myocardial ischemia improve identification of myocardial injury after noncardiac surgery?” The literature review is used to provide the educational framework to improve provider knowledge. The overall objective is to increase awareness with the intention of improving healthcare outcomes for surgical patients.

Methodology: The primary methodology of the proposed project is to administer an online educational intervention to providers which focuses on the benefits of perioperative troponin monitoring in the early identification of MINS. Pre- and post-assessment surveys will be used to measure improvement of provider knowledge before and after the intervention.

Results: Overall, there was an improvement in provider knowledge following the education intervention. Additionally, the likelihood of utilizing perioperative troponin monitoring increased among providers.

Conclusions: Currently, troponin monitoring is not standard practice in high-risk patients undergoing major noncardiac surgery. The educational intervention provided was effective in improving anesthesia provider knowledge of MINS and the likelihood of utilizing perioperative troponin monitoring. Increasing awareness of myocardial injury after noncardiac surgery and the role of serial troponin monitoring can reduce mortality and improve postoperative outcomes.

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