Giovanna Lurati Buse1, Braden Manns1, Andre Lamy1, Gordon Guyatt1, Carisi A Polanczyk1, Matthew T V Chan1, Chew Yin Wang1, Juan Carlos Villar1, Alben Sigamani1, Daniel I Sessler1, Otavio Berwanger1, Bruce M Biccard1, Rupert Pearse1, Gerard Urrútia1, Wojciech Szczeklik1, Ignacio Garutti1, Sadeesh Srinathan1, German Malaga1, Valsa Abraham1, Clara K Chow1, Michael J Jacka1, Maria Tiboni1, Gareth Ackland1, Danielle Macneil1, Robert Sapsford1, Martin Leuwer1, Yannick Le Manach1, Philip J Devereaux1. 1. From the University Hospital of Düsseldorf, Düsseldorf, Germany (Lurati Buse); the University Hospital of Basel, Basel, Switzerland (Lurati Buse); the University of Calgary, Calgary, Alta. (Manns); McMaster University, Hamilton, Ont. (Lamy, Guyatt, Tiboni, Devereaux); the Hospital de Clínicas de Porto Alegre, Universidade Federal de Rio Grande do Sul, Brazil (Polanczyk); the Chinese University of Hong Kong, Sha Tin, NT, Hong Kong (Chan); the University of Malaya, Kuala Lampur, Malaysia (Wang); the Fundación Cardioinfantil - Instituto de Cardiología, Bogotá and Universidad Autónoma de Bucaramanga, Bucaramanga, Colombia (Villar); St. John's Medical College and Research Institute, Bangalore, India (Sigamani); the Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio (Sessler); the HCor Research Institute (Hospital do CoraÇão), São Paulo, Brazil (Berwanger); the Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa (Biccard); Barts and The London School of Medicine and Dentistry, London, UK (Pearse); the Hospital de Sant Pau, Barcelona, Spain (Urrútia); the Jagiellonian University Medical College, Krakow, Poland (Szczeklik); the Hospital General Universitario Gregorio Marañón, Madrid, Spain (Garutti); the University of Manitoba, Winnipeg, Man. (Srinathan); the Universidad Peruana Cayetano Heredia, Lima, Peru (Malaga); the Christian Medical College, Ludhiana, India (Abraham); the George Institute for Global Health, University of Sydney, Sydney, Australia (Chow); the University of Alberta Hospital, Edmonton, Alta. (Jacka); the University College London, London, UK (Ackland); the London Health Sciences Centre, London, Ont. (Macneil); the University of Leeds, Leeds, UK (Sapsford); the Royal Liverpool Broadgreen University Hospital Trust, Liverpool, UK (Leuwer); and the HÔpital Pitié-Salpêtrière, Paris, France (Le Manach).
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.
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.
Authors: Thomas G Weiser; Scott E Regenbogen; Katherine D Thompson; Alex B Haynes; Stuart R Lipsitz; William R Berry; Atul A Gawande Journal: Lancet Date: 2008-06-24 Impact factor: 79.321
Authors: Emmanuelle Duceppe; Joel Parlow; Paul MacDonald; Kristin Lyons; Michael McMullen; Sadeesh Srinathan; Michelle Graham; Vikas Tandon; Kim Styles; Amal Bessissow; Daniel I Sessler; Gregory Bryson; P J Devereaux Journal: Can J Cardiol Date: 2016-10-04 Impact factor: 5.223
Authors: P J Devereaux; Denis Xavier; Janice Pogue; Gordon Guyatt; Alben Sigamani; Ignacio Garutti; Kate Leslie; Purnima Rao-Melacini; Sue Chrolavicius; Homer Yang; Colin Macdonald; Alvaro Avezum; Luc Lanthier; Weijiang Hu; Salim Yusuf Journal: Ann Intern Med Date: 2011-04-19 Impact factor: 25.391
Authors: Emmanuelle Duceppe; Salim Yusuf; Vikas Tandon; Reitze Rodseth; Bruce M Biccard; Denis Xavier; Wojciech Szczeklik; Christian S Meyhoff; Maria Grazia Franzosi; Jessica Vincent; Sadeesh K Srinathan; Joel Parlow; Patrick Magloire; John Neary; Mangala Rao; Navneet K Chaudhry; Bongani Mayosi; Miriam de Nadal; Ekaterine Popova; Juan Carlos Villar; Fernando Botto; Otavio Berwanger; Gordon Guyatt; John W Eikelboom; Daniel I Sessler; Clive Kearon; Shirley Pettit; Stuart J Connolly; Mukul Sharma; Shrikant I Bangdiwala; P J Devereaux Journal: Can J Cardiol Date: 2018-02-02 Impact factor: 5.223
Authors: Fernando Botto; Pablo Alonso-Coello; Matthew T V Chan; Juan Carlos Villar; Denis Xavier; Sadeesh Srinathan; Gordon Guyatt; Patricia Cruz; Michelle Graham; C Y Wang; Otavio Berwanger; Rupert M Pearse; Bruce M Biccard; Valsa Abraham; German Malaga; Graham S Hillis; Reitze N Rodseth; Deborah Cook; Carisi A Polanczyk; Wojciech Szczeklik; Daniel I Sessler; Tej Sheth; Gareth L Ackland; Martin Leuwer; Amit X Garg; Yannick Lemanach; Shirley Pettit; Diane Heels-Ansdell; Giovanna Luratibuse; Michael Walsh; Robert Sapsford; Holger J Schünemann; Andrea Kurz; Sabu Thomas; Marko Mrkobrada; Lehana Thabane; Hertzel Gerstein; Pilar Paniagua; Peter Nagele; Parminder Raina; Salim Yusuf; P J Devereaux; P J Devereaux; Daniel I Sessler; Michael Walsh; Gordon Guyatt; Matthew J McQueen; Mohit Bhandari; Deborah Cook; Jackie Bosch; Norman Buckley; Salim Yusuf; Clara K Chow; Graham S Hillis; Richard Halliwell; Stephen Li; Vincent W Lee; John Mooney; Carisi A Polanczyk; Mariana V Furtado; Otavio Berwanger; Erica Suzumura; Eliana Santucci; Katia Leite; Jose Amalth do Espirirto Santo; Cesar A P Jardim; Alexandre Biasi Cavalcanti; Helio Penna Guimaraes; Michael J Jacka; Michelle Graham; Finlay McAlister; Sean McMurtry; Derek Townsend; Neesh Pannu; Sean Bagshaw; Amal Bessissow; Mohit Bhandari; Emmanuelle Duceppe; John Eikelboom; Javier Ganame; James Hankinson; Stephen Hill; Sanjit Jolly; Andre Lamy; Elizabeth Ling; Patrick Magloire; Guillaume Pare; Deven Reddy; David Szalay; Jacques Tittley; Jeff Weitz; Richard Whitlock; Saeed Darvish-Kazim; Justin Debeer; Peter Kavsak; Clive Kearon; Richard Mizera; Martin O'Donnell; Matthew McQueen; Jehonathan Pinthus; Sebastian Ribas; Marko Simunovic; Vikas Tandon; Tomas Vanhelder; Mitchell Winemaker; Hertzel Gerstein; Sarah McDonald; Paul O'Bryne; Ameen Patel; James Paul; Zubin Punthakee; Karen Raymer; Omid Salehian; Fred Spencer; Stephen Walter; Andrew Worster; Anthony Adili; Catherine Clase; Deborah Cook; Mark Crowther; James Douketis; Azim Gangji; Paul Jackson; Wendy Lim; Peter Lovrics; Sergio Mazzadi; William Orovan; Jill Rudkowski; Mark Soth; Maria Tiboni; Rey Acedillo; Amit Garg; Ainslie Hildebrand; Ngan Lam; Danielle Macneil; Marko Mrkobrada; Pavel S Roshanov; Sadeesh K Srinathan; Clare Ramsey; Philip St John; Laurel Thorlacius; Faisal S Siddiqui; Hilary P Grocott; Andrew McKay; Trevor W R Lee; Ryan Amadeo; Duane Funk; Heather McDonald; James Zacharias; Juan Carlos Villar; Olga Lucía Cortés; Maria Stella Chaparro; Skarlett Vásquez; Alvaro Castañeda; Silvia Ferreira; Pierre Coriat; Denis Monneret; Jean Pierre Goarin; Cristina Ibanez Esteve; Catherine Royer; Georges Daas; Matthew T V Chan; Gordon Y S Choi; Tony Gin; Lydia C W Lit; Denis Xavier; Alben Sigamani; Atiya Faruqui; Radhika Dhanpal; Smitha Almeida; Joseph Cherian; Sultana Furruqh; Valsa Abraham; Lalita Afzal; Preetha George; Shaveta Mala; Holger Schünemann; Paola Muti; Enrico Vizza; C Y Wang; G S Y Ong; Marzida Mansor; Alvin S B Tan; Ina I Shariffuddin; V Vasanthan; N H M Hashim; A Wahab Undok; Ushananthini Ki; Hou Yee Lai; Wan Azman Ahmad; Azad H A Razack; German Malaga; Vanessa Valderrama-Victoria; Javier D Loza-Herrera; Maria De Los Angeles Lazo; Aida Rotta-Rotta; Wojciech Szczeklik; Barbara Sokolowska; Jacek Musial; Jacek Gorka; Pawel Iwaszczuk; Mateusz Kozka; Maciej Chwala; Marcin Raczek; Tomasz Mrowiecki; Bogusz Kaczmarek; Bruce Biccard; Hussein Cassimjee; Dean Gopalan; Theroshnie Kisten; Aine Mugabi; Prebashini Naidoo; Rubeshan Naidoo; Reitze Rodseth; David Skinner; Alex Torborg; Pilar Paniagua; Gerard Urrutia; Mari Luz Maestre; Miquel Santaló; Raúl Gonzalez; Adrià Font; Cecilia Martínez; Xavier Pelaez; Marta De Antonio; Jose Marcial Villamor; Jesús Alvarez García; Maria José Ferré; Ekaterina Popova; Pablo Alonso-Coello; Ignacio Garutti; Patricia Cruz; Carmen Fernández; Maria Palencia; Susana Díaz; Teresa Del Castillo; Alberto Varela; Angeles de Miguel; Manuel Muñoz; Patricia Piñeiro; Gabriel Cusati; Maria Del Barrio; Maria José Membrillo; David Orozco; Fidel Reyes; Robert J Sapsford; Julian Barth; Julian Scott; Alistair Hall; Simon Howell; Michaela Lobley; Janet Woods; Susannah Howard; Joanne Fletcher; Nikki Dewhirst; C Williams; A Rushton; I Welters; M Leuwer; Rupert Pearse; Gareth Ackland; Ahsun Khan; Edyta Niebrzegowska; Sally Benton; Andrew Wragg; Andrew Archbold; Amanda Smith; Eleanor McAlees; Cheryl Ramballi; Neil Macdonald; Marta Januszewska; Robert Stephens; Anna Reyes; Laura Gallego Paredes; Pervez Sultan; David Cain; John Whittle; Ana Gutierrez Del Arroyo; Daniel I Sessler; Andrea Kurz; Zhuo Sun; Patrick S Finnegan; Cameron Egan; Hooman Honar; Aram Shahinyan; Krit Panjasawatwong; Alexander Y Fu; Sihe Wang; Edmunds Reineks; Peter Nagele; Jane Blood; Megan Kalin; David Gibson; Troy Wildes Journal: Anesthesiology Date: 2014-03 Impact factor: 7.892