The Ultimate Life Test?

Imagine a simple blood test that could tell you if you’re going to die. Would that be super cool or super scary?  Well, imagine no more, it turns out there is such a test.

Researchers at McMaster University have found a test that can identify people who are at high risk of dying in the month after surgery.  Apparently elevated levels of troponin T (a protein marker of heart injury) correlate with an increased risk of death.

Currently, troponin levels are not commonly measured after most types of surgery.

The results from the Vascular Events In Non-cardiac Surgery Patients Cohort Evaluation (VISION) study, the largest international prospective study evaluating complications after surgery, have just been published in the Journal of the American Medical Association (JAMA).

VISION enrolled 15,133 adult patients in North and South America, Asia, Australia, and Europe.  Troponin T was measured daily during the first three days after surgery. Patients were followed while in the hospital and at 30 days after surgery.

VISION demonstrated that a simple blood test strongly identifies which non-cardiac surgery patients are at high risk of dying in the next 30 days,” said Dr. P.J. Devereaux, VISION principal investigator.

According to Devereaux the results also demonstrated that most patients did not die until an average of six or more days after their troponin T blood test was identified as elevated. “This holds out great hope that there is time to intervene.”

Knowing who is at risk through the test can help physicians target patients who need enhanced observation or interventions.

Surgery activates pathways of inflammation, stress, and clotting that predispose the heart to injury. As a result, many patients suffer heart attacks after surgery. The majority of these patients, however, will not experience chest pain. Evidence from this study supports experts who have advocated the use of troponin blood tests after surgery.

The VISION study suggests that myocardial injury detected through elevated troponin T may explain 42% of deaths that occur after surgery.

This study has substantial potential to change how patients are monitored after surgery,” said Dr. Jean Rouleau, scientific director of the Institute for Circulatory and Respiratory Health of the Canadian Institutes of Health Research. “These results hold substantial promise that through measuring troponin blood tests after surgery, physicians can identify which patients are at high-risk of dying and this can allow them to consider enhanced monitoring and interventions in an attempt to improve outcomes. This is a good example of how a carefully conducted clinical study can impact  patient care.”

SRxA’s Word on Health would like to know if you would take the test.

Calculating the Cost of Self-Castration

SRxA’s Word on Health brings you another in our series of “Don’t Try This at Home,” and a word of warning – squeamish gentlemen may want to look away at this point.

The Journal of Sexual Medicine recently published a report entitled “Self-Castration by a Transsexual Woman: Financial and Psychological Costs: A Case Report.”  In it physicians from the GW School of Medicine and Health Sciences discuss the case of a transsexual woman who presented to the emergency room hemorrhaging after undertaking self-castration.

Unsurprisingly, the researchers found that the health care costs associated with treating a patient after self-castration were almost four times greater than if they had undergone an elective outpatient surgical castration.

In this particular case the patient had to undergo emergency surgery including bilateral inguinal exploration, ligation and removal of bilateral spermatic cords, complicated scrotal exploration, debridement, and closure. The patient was then admitted to the psychiatric service for a hospital stay of three days. The total bill was $14,923, rather than the $4,000 it would have cost for an elective outpatient orchiectomy in the patient’s geographical area.

So what on earth would make a patient do this?  According to the authors, the out-of-pocket cost for an elective castration are not covered by health insurance. Additionally, lack of access to a surgeon willing to perform the operation, long waiting times, and underlying psychological and psychiatric conditions may lead transsexual women to attempt the ultimate act of self-mutilation. Patients are often frustrated at the slow pace of their male-to-female transition or lack the money to make it.

But as this report demonstrates, from a financial standpoint, an elective orchiectomy can cost the health care system significantly less than an emergency hospital admission. From a patient safety standpoint, elective orchiectomy is preferable to self-castration which carries significant risks such as hemorrhage, disfigurement, infection, urinary fistulae, and nerve damage.

The authors urge healthcare providers of transsexual women to carefully explore patient attitudes toward self-castration and work toward improving access to elective orchiectomy.

Additionally, in order to reduce the number of self-castrations, Word on Health suggests that more urologists who are willing to perform surgery on transsexuals should be identified and more pressure needs to be put on health care insurance companies to cover the procedure.