Alex Torborg1, Lisa Ryan, Gary Kantor, Bruce M Biccard. 1. Perioperative Research Group, Department of Anaesthetics, Nelson R Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal and Inkosi Albert Luthuli Central Hospital, Durban, South Africa. alexandra@iafrica.com.
Abstract
BACKGROUND: A postoperative troponin leak that was previously considered clinically insignificant has been independently associated with 30-day mortality in unselected surgical patients ≥45 years of age following non-cardiac surgery. OBJECTIVES: To determine whether routine troponin surveillance following non-cardiac surgery and initiation of aspirin and statin therapy in troponin-positive patients is cost-effective. METHODS: Pharmacoeconomic analysis to determine the cost-effectiveness of routine postoperative surveillance for patients aged ≥45 years undergoing non-cardiac surgery. We compared the total expected cost of hospital care of patients who received routine troponin surveillance and subsequent introduction of statin and aspirin therapy for 30 days in troponin-positive patients with the cost of hospital care of patients who did not receive troponin surveillance. We estimated a 25% relative risk reduction following statin and aspirin therapy for postoperative vascular mortality and non-fatal myocardial infarction. RESULTS: Routine troponin surveillance with initiation of aspirin and statin therapy was cost-effective, with an incremental cost of -R16,724 per event avoided. CONCLUSION: Routine postoperative troponin surveillance in non-cardiac surgical patients ≥45 years of age requiring a postoperative night in hospital is potentially cost-effective.
BACKGROUND: A postoperative troponin leak that was previously considered clinically insignificant has been independently associated with 30-day mortality in unselected surgical patients ≥45 years of age following non-cardiac surgery. OBJECTIVES: To determine whether routine troponin surveillance following non-cardiac surgery and initiation of aspirin and statin therapy in troponin-positive patients is cost-effective. METHODS: Pharmacoeconomic analysis to determine the cost-effectiveness of routine postoperative surveillance for patients aged ≥45 years undergoing non-cardiac surgery. We compared the total expected cost of hospital care of patients who received routine troponin surveillance and subsequent introduction of statin and aspirin therapy for 30 days in troponin-positive patients with the cost of hospital care of patients who did not receive troponin surveillance. We estimated a 25% relative risk reduction following statin and aspirin therapy for postoperative vascular mortality and non-fatal myocardial infarction. RESULTS: Routine troponin surveillance with initiation of aspirin and statin therapy was cost-effective, with an incremental cost of -R16,724 per event avoided. CONCLUSION: Routine postoperative troponin surveillance in non-cardiac surgical patients ≥45 years of age requiring a postoperative night in hospital is potentially cost-effective.
Authors: 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; Wojciech Szczeklik; Ignacio Garutti; Sadeesh Srinathan; German Malaga; Valsa Abraham; Clara K Chow; Michael J Jacka; Maria Tiboni; Gareth Ackland; Danielle Macneil; Robert Sapsford; Martin Leuwer; Yannick Le Manach; Philip J Devereaux Journal: Can J Surg Date: 2018-06 Impact factor: 2.089
Authors: Annemarie Akkermans; Linda M Peelen; Judith A van Waes; Gabriël J Rinkel; Wilton A van Klei Journal: Eur J Prev Cardiol Date: 2018-05-17 Impact factor: 7.804