PT  - JOURNAL ARTICLE
AU  - Giovanna Lurati Buse
AU  - Braden Manns
AU  - Andre Lamy
AU  - Gordon Guyatt
AU  - Carisi A. Polanczyk
AU  - Matthew T.V. Chan
AU  - Chew Yin Wang
AU  - Juan Carlos Villar
AU  - Alben Sigamani
AU  - Daniel I. Sessler
AU  - Otavio Berwanger
AU  - Bruce M. Biccard
AU  - Rupert Pearse
AU  - Gerard Urrútia
AU  - R. Wojciech Szczeklik
AU  - Ignacio Garutti
AU  - Sadeesh Srinathan
AU  - German Malaga
AU  - Valsa Abraham
AU  - Clara K. Chow
AU  - Michael J. Jacka
AU  - Maria Tiboni
AU  - Gareth Ackland
AU  - Danielle Macneil
AU  - Robert Sapsford
AU  - Martin Leuwer
AU  - Yannick Le Manach
AU  - Philip J. Devereaux
TI  - Troponin T monitoring to detect myocardial injury after noncardiac surgery: a cost–consequence analysis
AID  - 10.1503/cjs.010217
DP  - 2018 Jun 01
TA  - Canadian Journal of Surgery
PG  - 185--194
VI  - 61
IP  - 3
4099  - http://canjsurg.ca/content/61/3/185.short
4100  - http://canjsurg.ca/content/61/3/185.full
SO  - CAN J SURG2018 Jun 01; 61
AB  - 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.