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

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dc.contributor.author Buse, Giovanna Lurati
dc.contributor.author Manns, Braden
dc.contributor.author Lamy, Andre
dc.contributor.author Guyatt, Gordon
dc.contributor.author Polanczyk, Carisi A.
dc.contributor.author Chan, Matthew T. V.
dc.contributor.author Wang, Chew Yin
dc.contributor.author Villar, Juan Carlos
dc.contributor.author Sigamani, Alben
dc.contributor.author Sessler, Daniel I.
dc.contributor.author Berwanger, Otavio
dc.contributor.author Biccard, Bruce M.
dc.contributor.author Pearse, Rupert
dc.contributor.author Urrútia, Gerard
dc.contributor.author Szczeklik, Wojciech
dc.contributor.author Garutti, Ignacio
dc.contributor.author Srinathan, Sadeesh
dc.contributor.author Malaga, German
dc.contributor.author Abraham, Valsa
dc.contributor.author Chow, Clara K.
dc.contributor.author Jacka, Michael J.
dc.contributor.author Tiboni, Maria
dc.contributor.author Ackland, Gareth
dc.contributor.author Macneil, Danielle
dc.contributor.author Sapsford, Robert
dc.contributor.author Leuwer, Martin
dc.contributor.author Le Manach, Yannick
dc.contributor.author Devereaux, Philip J.
dc.date.accessioned 2018-11-30T23:41:30Z
dc.date.available 2018-11-30T23:41:30Z
dc.date.issued 2018
dc.identifier.uri https://dx.doi.org/10.1503%2Fcjs.010217
dc.identifier.uri http://repositorio.upch.edu.pe/handle/upch/4204
dc.description.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.
dc.language.iso eng
dc.publisher Canadian Medical Association
dc.rights info:eu-repo/semantics/restrictedAccess
dc.rights.uri https://creativecommons.org/licenses/by-nc-nd/4.0/deed.es
dc.title Troponin T monitoring to detect myocardial injury after noncardiac surgery: a cost-consequence analysis
dc.type info:eu-repo/semantics/article
dc.identifier.journal Canadian Journal of Surgery

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