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BMJ Open. 2017 Aug 18;7(8):e015828. doi: 10.1136/bmjopen-2017-015828.

Validation of days at home as an outcome measure after surgery: a prospective cohort study in Australia.

Author information

1
Department of Anaesthesia and Perioperative Medicine, Alfred Hospital, Melbourne, Victoria, Australia.
2
Department of Anaesthesia and Perioperative Medicine, Monash University, Melbourne, Victoria, Australia.
3
Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
4
Toronto General Hospital and University of Toronto, Toronto, Ontario, Canada.

Abstract

OBJECTIVE:

To evaluate 'days at home up to 30 days after surgery' (DAH30) as a patient-centred outcome measure.

DESIGN:

Prospective cohort study.

DATA SOURCE:

Using clinical trial data (seven trials, 2109 patients) we calculated DAH30 from length of stay, readmission, discharge destination and death up to 30 days after surgery.

MAIN OUTCOME:

The association between DAH30 and serious complications after surgery.

RESULTS:

One or more complications occurred in 263 of 1846 (14.2%) patients, including 19 (1.0%) deaths within 30 days of surgery; 245 (11.6%) patients were discharged to a rehabilitation facility and 150 (7.1%) were readmitted to hospital within 30 days of surgery. The median DAH30 was significantly less in older patients (p<0.001), those with poorer physical functioning (p<0.001) and in those undergoing longer operations (p<0.001). Patients with serious complications had less days at home than patients without serious complications (20.5 (95% CI 19.1 to 21.9) vs 23.9 (95% CI 23.8 to 23.9) p<0.001), and had higher rates of readmission (16.0% vs 5.9%; p<0.001). After adjusting for patient age, sex, physical status and duration of surgery, the occurrence of postoperative complications was associated with fewer days at home after surgery (difference 3.0(95% CI 2.1 to 4.0) days; p<0.001).

CONCLUSIONS:

DAH30 has construct validity and is a readily obtainable generic patient-centred outcome measure. It is a pragmatic outcome measure for perioperative clinical trials.

KEYWORDS:

clinical trials; outcome; perioperative medicine

PMID:
28821518
PMCID:
PMC5629653
DOI:
10.1136/bmjopen-2017-015828
[Indexed for MEDLINE]
Free PMC Article

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