Troponin T monitoring to detect myocardial injury after noncardiac surgery: A cost-consequence analysis

Giovanna Lurati Buse, Braden Manns, Andre Lamy, Gordon Guyatt, Carisi A. Polanczyk, Matthew T.V. Chan, Chew Yin Wang, Juan Carlos Villar, Alben Sigamani, Daniel I. Sessler, Otavio Berwanger, Bruce M. Biccard, Rupert Pearse, Gerard Urrútia, R. Wojciech Szczeklik, Ignacio Garutti, Sadeesh Srinathan, German Malaga, Valsa Abraham, Clara K. ChowMichael J. Jacka, Maria Tiboni, Gareth Ackland, Danielle Macneil, Robert Sapsford, Martin Leuwer, Yannick Le Manach, Philip J. Devereaux

Research output: Contribution to journalArticlepeer-review

19 Scopus citations

Abstract

Background: Myocardial injury after noncardiac surgery (MINS) is a mostly asymptomatic condition that is strongly associated with 30-day mortality; however, it remains mostly undetected without systematic troponin T monitoring. We evaluated the cost and consequences of postoperative troponin T monitoring to detect MINS. Methods: We conducted a model-based cost-consequence analysis to compare the impact of routine troponin T monitoring versus standard care (troponin T measurement triggered by ischemic symptoms) on the incidence of MINS detection. Model inputs were based on Canadian patients enrolled in the Vascular Events in Noncardiac Surgery Patients Cohort Evaluation (VISION) study, which enrolled patients aged 45 years or older undergoing inpatient noncardiac surgery. We conducted probability analyses with 10 000 iterations and extensive sensitivity analyses. Results: The data were based on 6021 patients (48% men, mean age 65 [standard deviation 12] yr). The 30-day mortality rate for MINS was 9.6%. We determined the incremental cost to avoid missing a MINS event as $1632 (2015 Canadian dollars). The cost-effectiveness of troponin monitoring was higher in patient subgroups at higher risk for MINS, e.g., those aged 65 years or more, or with a history of atherosclerosis or diabetes ($1309). Conclusion: The costs associated with a troponin T monitoring program to detect MINS were moderate. Based on the estimated incremental cost per health gain, implementation of postoperative troponin T monitoring seems appealing, particularly in patients at high risk for MINS.

Original languageEnglish
Pages (from-to)185-194
Number of pages10
JournalCanadian Journal of Surgery
Volume61
Issue number3
DOIs
StatePublished - Jun 2018

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