Research

The pharmacoeconomics of routine postoperative troponin surveillance to prevent and treat myocardial infarction after non-cardiac surgery

Alex Torborg, Lisa Ryan, Gary Kantor, Bruce M Biccard

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.

Authors' affiliations

Alex Torborg, 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

Lisa Ryan, 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; Department of Anaesthetics, Grey’s Hospital, Pietermaritzburg, KwaZulu-Natal, South Africa

Gary Kantor, Department of Anaesthesiology, Faculty of Health Sciences, University of Cape Town, South Africa; Department of Anesthesiology and Perioperative Medicine, Case Western Reserve University, Cleveland, Ohio, USA

Bruce M Biccard, 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

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Keywords

Surgery; Mortality; Myocardial infarction; Troponin

Cite this article

South African Medical Journal 2014;104(9):619-623. DOI:10.7196/SAMJ.7654

Article History

Date submitted: 2013-10-25
Date published: 2014-07-22

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