None listed
Conditions
Brief summary
The purpose of this study is to find out whether the number of heart operations performed on people aged 90 years and older in Australia and New Zealand has changed over the past 15 years, and whether patients treated in public hospitals have different outcomes from those treated in private hospitals. To do this, we will look back at existing de-identified records held in a national intensive care registry for every patient aged 90 or older who was admitted to intensive care after open heart surgery, a heart valve operation, a coronary artery bypass, or both together, between 1 January 2010 and 31 December 2024. This is an observational study: we will only study information that has already been collected as part of routine care, so there is no new treatment, no randomisation into groups, and no contact with patients; the two groups being compared are simply patients treated in public hospitals and patients treated in private hospitals. We expect to find that the share of these operations taking place in public hospitals has fallen over time, and this is our main hypothesis; we also want to learn whether the sector of the hospital is linked to a patient's chance of going straight home after surgery, being transferred to another hospital, dying in intensive care or in hospital, or surviving over the following years. Because the two groups of patients may differ from the outset, we will take account of measured differences such as age, sex, type of operation, whether the surgery was planned or urgent, the year of surgery, and the level of social advantage in the area where the patient lives. Finally, we will check how well an existing risk score used in Australian and New Zealand intensive care units predicts death in hospital for patients of this age, so that in future patients and their families can be given more accurate information when deciding whether to proceed with surgery.
Interventions
This is an observational cohort study using routinely collected clinical quality registry data. There is no study intervention, no randomisation, no allocation of treatment and no participant contact. Investigators do not influence any aspect of clinical care.
Data will be collected from The Australian and New Zealand Intensive Care Society (ANZICS) Centre for Outcome Resource Evaluation (CORE) Registry, which is a world-leading clinical quality registry managed by ANZICS. We will collect data
This is an observational cohort study using routinely collected clinical quality registry data. There is no study intervention, no randomisation, no allocation of treatment and no participant contact. Investigators do not influence any aspect of clinical care. Data will be collected from The Australian and New Zealand Intensive Care Society (ANZICS) Centre for Outcome Resource Evaluation (CORE) Registry, which is a world-leading clinical quality registry managed by ANZICS. We will collect data from the The Adult Patient Database (APD), which contains data from over 3.5 million patient episodes of care and is one of the largest single datasets of intensive care in the world. The database collects admission data from over 97% of intensive care units (ICU) across Australia and New Zealand. Data is used to benchmark the performance of individual contributing units. Analysis of data is reported back to contributing sites via the CORE Portal online reporting tool. Data collected will include registry information about individual episodes of care in ICU. Data includes biochemical, physiological and demographic information required for the calculation of severity of illness scores, together with dates and times of admission and discharge, some data on therapies received during the ICU stay and information about patients’ outcomes. We will only be collecting data on nonagenarians who have undergone any open cardiac procedures including surgery type, duration of surgery, complications or adverse events. The overall duration of observation, will be from acute admission for cardiac surgery up to 2 years post-surgery or death, whichever occurs first. Follow up data will be collected from the registry, which is routinely collected from birth and deaths registry data. Patients will not be contacted. No other hospital admissions will be reviewed. The exposure of interest is the funding and governance sector of the hospital in which open cardiac surgery and subsequent intensive care admission occurred, classified as public or private. Sector is a hospital (site) level characteristic recorded by the ANZICS CORE APD, and is not assigned by the investigators. Each eligible index intensive care unit admission is classified according to the sector designation in force for that site at the time of that admission; where a site changes classification during the study period, admissions are assigned the contemporaneous classification. A unit designated as a public hospital under private management is assigned to the public sector in the primary analysis, because admission occurs through a public hospital pathway; reassignment to the private sector is examined in a prespecified sensitivity analysis.
Sponsors
Austin Health
Eligibility
Sex/Gender
All
Age
90 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Eligible records are index intensive care unit admissions meeting all of the following criteria: 1. Admission to an adult intensive care unit in Australia or New Zealand that contributed data to the ANZICS CORE Adult Patient Database, with ICU admission occurring between 1 January 2010 and 31 December 2024 inclusive. 2. Age 90.00 years or older at the time of ICU admission. 3. An APACHE III admission diagnostic code corresponding to open cardiac surgery, specifically 1206 (cardiac valve surgery), 1207 (coronary artery bypass grafting), or 1212 (combined valve surgery and coronary artery bypass grafting). 4. The record is the first ICU admission of the qualifying surgical hospitalisation (admission-episode sequence of 1). 5. The record contains sufficient information to permit confirmation of the above criteria after application of the APD Data Dictionary.
Exclusion criteria
1. A second or subsequent ICU admission within the same hospitalisation, identified by an admission-episode sequence of 2 or greater. Only the first ICU admission from each qualifying surgical hospitalisation is retained. 2. A record that does not permit confirmation of the inclusion criteria after application of the APD Data Dictionary.
Outcome results
None listed