Days at Home after Surgery: An Integrated and Efficient Outcome Measure for Clinical Trials and Quality Assurance

Max Bell, Lars I. Eriksson, Tobias Svensson, Linn Hallqvist, Fredrik Granath, Jennifer Reilly, Paul S. Myles

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Background: Surgical audit, sometimes including public reporting, is an important foundation of high quality health care. We aimed to assess the validity of a novel outcome metric, days at home up to 30 days after surgery, as a surgical outcome measure in clinical trials and quality assurance. Methods: This was a multicentre, registry-based cohort study. We used prospectively collected hospital and national healthcare registry data obtained from patients aged 18 years or older undergoing a broad range of surgeries in Sweden over a 10-year period. The association between days at home up to 30 days after surgery and patient (older age, poorer physical status, comorbidity) and surgical (elective or non-elective, complexity, duration) risk factors, process of care outcomes (re-admissions, discharge destination), clinical outcomes (major complications, 30-day mortality) and death up to 1 year after surgery were measured. Findings: From January, 2005, to December, 2014, we obtained demographic and perioperative data on 636,885 patients from 21 Swedish hospitals. Mortality at 30 days and one year was 1.8% and 7.3%, respectively. The median (IQR) days at home up to 30 days after surgery was 27 (23–29), being significantly lower among high-risk patients, those recovering from more complex surgical procedures, and suffering serious postoperative complications (all p < 0.0001). Patients with 8 days or less at home up to 30 days after surgery had a nearly 7-fold higher risk of death up to 1 year postoperatively when compared with those with 29 or 30 days at home (adjusted HR 6.78 [95% CI: 6.44–7.13]). Interpretation: Days at home up to 30 days after surgery is a valid, easy to measure patient-centred outcome metric. It is highly sensitive to changes in surgical risk and impact of complications, and has prognostic importance; it is therefore a valuable endpoint for perioperative clinical trials and quality assurance. Funding: Swedish National Research Council Medicine and Stockholm County Council ALF-project grant (LE), and the Australian National Health and Medical Research Council (PM).

Original languageEnglish
Pages (from-to)1-9
Number of pages9
JournaleClinical Medicine
DOIs
Publication statusAccepted/In press - 27 Apr 2019

Keywords

  • Anaesthesia
  • Audit
  • Patient-reported outcome measures
  • Postoperative complications
  • Surgery
  • Survival

Cite this

@article{ecd99093802a4b0cad14efcbe88e4669,
title = "Days at Home after Surgery: An Integrated and Efficient Outcome Measure for Clinical Trials and Quality Assurance",
abstract = "Background: Surgical audit, sometimes including public reporting, is an important foundation of high quality health care. We aimed to assess the validity of a novel outcome metric, days at home up to 30 days after surgery, as a surgical outcome measure in clinical trials and quality assurance. Methods: This was a multicentre, registry-based cohort study. We used prospectively collected hospital and national healthcare registry data obtained from patients aged 18 years or older undergoing a broad range of surgeries in Sweden over a 10-year period. The association between days at home up to 30 days after surgery and patient (older age, poorer physical status, comorbidity) and surgical (elective or non-elective, complexity, duration) risk factors, process of care outcomes (re-admissions, discharge destination), clinical outcomes (major complications, 30-day mortality) and death up to 1 year after surgery were measured. Findings: From January, 2005, to December, 2014, we obtained demographic and perioperative data on 636,885 patients from 21 Swedish hospitals. Mortality at 30 days and one year was 1.8{\%} and 7.3{\%}, respectively. The median (IQR) days at home up to 30 days after surgery was 27 (23–29), being significantly lower among high-risk patients, those recovering from more complex surgical procedures, and suffering serious postoperative complications (all p < 0.0001). Patients with 8 days or less at home up to 30 days after surgery had a nearly 7-fold higher risk of death up to 1 year postoperatively when compared with those with 29 or 30 days at home (adjusted HR 6.78 [95{\%} CI: 6.44–7.13]). Interpretation: Days at home up to 30 days after surgery is a valid, easy to measure patient-centred outcome metric. It is highly sensitive to changes in surgical risk and impact of complications, and has prognostic importance; it is therefore a valuable endpoint for perioperative clinical trials and quality assurance. Funding: Swedish National Research Council Medicine and Stockholm County Council ALF-project grant (LE), and the Australian National Health and Medical Research Council (PM).",
keywords = "Anaesthesia, Audit, Patient-reported outcome measures, Postoperative complications, Surgery, Survival",
author = "Max Bell and Eriksson, {Lars I.} and Tobias Svensson and Linn Hallqvist and Fredrik Granath and Jennifer Reilly and Myles, {Paul S.}",
year = "2019",
month = "4",
day = "27",
doi = "10.1016/j.eclinm.2019.04.011",
language = "English",
pages = "1--9",
journal = "eClinical Medicine",
issn = "2589-5370",

}

Days at Home after Surgery : An Integrated and Efficient Outcome Measure for Clinical Trials and Quality Assurance. / Bell, Max; Eriksson, Lars I.; Svensson, Tobias; Hallqvist, Linn; Granath, Fredrik; Reilly, Jennifer; Myles, Paul S.

In: eClinical Medicine, 27.04.2019, p. 1-9.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Days at Home after Surgery

T2 - An Integrated and Efficient Outcome Measure for Clinical Trials and Quality Assurance

AU - Bell, Max

AU - Eriksson, Lars I.

AU - Svensson, Tobias

AU - Hallqvist, Linn

AU - Granath, Fredrik

AU - Reilly, Jennifer

AU - Myles, Paul S.

PY - 2019/4/27

Y1 - 2019/4/27

N2 - Background: Surgical audit, sometimes including public reporting, is an important foundation of high quality health care. We aimed to assess the validity of a novel outcome metric, days at home up to 30 days after surgery, as a surgical outcome measure in clinical trials and quality assurance. Methods: This was a multicentre, registry-based cohort study. We used prospectively collected hospital and national healthcare registry data obtained from patients aged 18 years or older undergoing a broad range of surgeries in Sweden over a 10-year period. The association between days at home up to 30 days after surgery and patient (older age, poorer physical status, comorbidity) and surgical (elective or non-elective, complexity, duration) risk factors, process of care outcomes (re-admissions, discharge destination), clinical outcomes (major complications, 30-day mortality) and death up to 1 year after surgery were measured. Findings: From January, 2005, to December, 2014, we obtained demographic and perioperative data on 636,885 patients from 21 Swedish hospitals. Mortality at 30 days and one year was 1.8% and 7.3%, respectively. The median (IQR) days at home up to 30 days after surgery was 27 (23–29), being significantly lower among high-risk patients, those recovering from more complex surgical procedures, and suffering serious postoperative complications (all p < 0.0001). Patients with 8 days or less at home up to 30 days after surgery had a nearly 7-fold higher risk of death up to 1 year postoperatively when compared with those with 29 or 30 days at home (adjusted HR 6.78 [95% CI: 6.44–7.13]). Interpretation: Days at home up to 30 days after surgery is a valid, easy to measure patient-centred outcome metric. It is highly sensitive to changes in surgical risk and impact of complications, and has prognostic importance; it is therefore a valuable endpoint for perioperative clinical trials and quality assurance. Funding: Swedish National Research Council Medicine and Stockholm County Council ALF-project grant (LE), and the Australian National Health and Medical Research Council (PM).

AB - Background: Surgical audit, sometimes including public reporting, is an important foundation of high quality health care. We aimed to assess the validity of a novel outcome metric, days at home up to 30 days after surgery, as a surgical outcome measure in clinical trials and quality assurance. Methods: This was a multicentre, registry-based cohort study. We used prospectively collected hospital and national healthcare registry data obtained from patients aged 18 years or older undergoing a broad range of surgeries in Sweden over a 10-year period. The association between days at home up to 30 days after surgery and patient (older age, poorer physical status, comorbidity) and surgical (elective or non-elective, complexity, duration) risk factors, process of care outcomes (re-admissions, discharge destination), clinical outcomes (major complications, 30-day mortality) and death up to 1 year after surgery were measured. Findings: From January, 2005, to December, 2014, we obtained demographic and perioperative data on 636,885 patients from 21 Swedish hospitals. Mortality at 30 days and one year was 1.8% and 7.3%, respectively. The median (IQR) days at home up to 30 days after surgery was 27 (23–29), being significantly lower among high-risk patients, those recovering from more complex surgical procedures, and suffering serious postoperative complications (all p < 0.0001). Patients with 8 days or less at home up to 30 days after surgery had a nearly 7-fold higher risk of death up to 1 year postoperatively when compared with those with 29 or 30 days at home (adjusted HR 6.78 [95% CI: 6.44–7.13]). Interpretation: Days at home up to 30 days after surgery is a valid, easy to measure patient-centred outcome metric. It is highly sensitive to changes in surgical risk and impact of complications, and has prognostic importance; it is therefore a valuable endpoint for perioperative clinical trials and quality assurance. Funding: Swedish National Research Council Medicine and Stockholm County Council ALF-project grant (LE), and the Australian National Health and Medical Research Council (PM).

KW - Anaesthesia

KW - Audit

KW - Patient-reported outcome measures

KW - Postoperative complications

KW - Surgery

KW - Survival

UR - http://www.scopus.com/inward/record.url?scp=85064694139&partnerID=8YFLogxK

U2 - 10.1016/j.eclinm.2019.04.011

DO - 10.1016/j.eclinm.2019.04.011

M3 - Article

SP - 1

EP - 9

JO - eClinical Medicine

JF - eClinical Medicine

SN - 2589-5370

ER -