Torborg Alex, Ryan Lisa, Kantor Gary, Biccard Bruce M
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.
S Afr Med J. 2014 Jul 22;104(9):619-23. doi: 10.7196/samj.7654.
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.
To determine whether routine troponin surveillance following non-cardiac surgery and initiation of aspirin and statin therapy in troponin-positive patients is cost-effective.
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.
Routine troponin surveillance with initiation of aspirin and statin therapy was cost-effective, with an incremental cost of -R16,724 per event avoided.
Routine postoperative troponin surveillance in non-cardiac surgical patients ≥45 years of age requiring a postoperative night in hospital is potentially cost-effective.
既往被认为临床意义不大的术后肌钙蛋白泄漏，已被证实与45岁及以上非心脏手术后未筛选的外科患者30天死亡率独立相关。
确定非心脏手术后进行常规肌钙蛋白监测以及对肌钙蛋白阳性患者启动阿司匹林和他汀类药物治疗是否具有成本效益。
进行药物经济学分析，以确定对45岁及以上接受非心脏手术的患者进行术后常规监测的成本效益。我们比较了接受常规肌钙蛋白监测并随后对肌钙蛋白阳性患者进行30天他汀类药物和阿司匹林治疗的患者的总预期住院费用，与未接受肌钙蛋白监测的患者的住院费用。我们估计他汀类药物和阿司匹林治疗术后血管性死亡率和非致命性心肌梗死的相对风险降低25%。
进行常规肌钙蛋白监测并启动阿司匹林和他汀类药物治疗具有成本效益，每避免一次事件的增量成本为-R16,724。
对于45岁及以上需要术后住院一晚的非心脏手术患者，术后常规肌钙蛋白监测可能具有成本效益。
