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Anaesthesia
Research
Validation of days at home as an outcome measure after surgery: a prospective cohort study in Australia
  1. Paul S Myles1,2,3,
  2. Mark A Shulman1,
  3. Stephane Heritier3,
  4. Sophie Wallace1,
  5. David R McIlroy1,2,
  6. Stuart McCluskey4,
  7. Isabella Sillar2,
  8. Andrew Forbes3
  1. 1 Department of Anaesthesia and Perioperative Medicine, Alfred Hospital, Melbourne, Victoria, Australia
  2. 2 Department of Anaesthesia and Perioperative Medicine, Monash University, Melbourne, Victoria, Australia
  3. 3 Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
  4. 4 Toronto General Hospital and University of Toronto, Toronto, Ontario, Canada
  1. Correspondence to Professor Paul S Myles; p.myles{at}alfred.org.au

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.

  • outcome
  • perioperative medicine
  • clinical trials

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/bmjopen-2017-015828

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    Footnotes

    • Contributors PSM designed the study, oversaw the ethics application, devised the statistical analysis plan, and drafted and revised the paper. He is the guarantor. MAS, DRM and SM provided intellectual input into the study design, and drafted and revised the paper. SH analysed the data and drafted and revised the paper. SW prepared the ethics application, monitored the data entry and checking, and drafted and revised the paper. IS retrieved and entered all study data, and revised the paper. AF contributed to the statistical analysis, and drafted and revised the paper.

    • Funding This work was supported by the Australian NHMRC, the New Zealand Health Research Council, and the Australian and New Zealand College of Anaesthetists, and Monash University (Melbourne, Australia).

    • Disclaimer PSM affirms that this manuscript is an honest, accurate and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned have been explained.

    • Competing interests None declared.

    • Ethics approval This trial has been approved by the Ethics Committee of Alfred Health, Melbourne, Australia.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement No additional data available.