Aged, Epidemiology, Mortality, SURGICAL PROCEDURES, OPERATIVE
Conditions
Brief summary
The investigators will conduct a population-based study using health administrative data to evaluate the impact of preoperative geriatric consultation on postoperative outcomes in older patients having elective, non-cardiac surgery
Detailed description
The investigators will use multilevel multivariable analyses to measure the association between preoperative geriatric assessment or consultation and outcomes after major elective non-cardiac surgery. Sensitivity analyses will be done to evaluate types and timing of geriatric care around surgery, as well as for effect modification based on patient and procedural factors.
Interventions
PROCEDUREPreoperative geriatric consult or assessment
A preoperative geriatric consult or assessment will be considered to be present if such a consult or assessment is billed by a geriatrician for a patient in the cohort within 4 months preceding surgery. For the primary analysis we will collapse both geriatric consultations and comprehensive geriatric assessments into a single exposure level.
PROCEDURENo Preoperative geriatric consult or assessment
No assessment or consult billed in the 4 months before surgery
Sponsors
Ottawa Hospital Research Institute
Study design
Observational model
COHORT
Time perspective
RETROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
65 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* \>65 * Resident of Ontario * Having elective non-cardiac surgery (inpatient admission)
Exclusion criteria
* Residing in a nursing home or long term care facility at baseline
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Number of Participants With All-Cause Mortality at 90-days | date of surgery to 90 days after surgery | Death from any cause in the 90 days after surgery |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Patient Safety Event | From surgery to hospital discharge (on average 6 to 7 days) | Any Type 2 diagnostic code for a patient-safety event |
| Hospital Length of Stay | date of surgery to date of hospital discharge, or 365 days after surgery, whichever comes first | — |
| Non-independent Discharge Location | date of surgery to date of hospital discharge, or 365 days after surgery, whichever comes first | Discharge disposition from hospital record that is not a home discharge without support |
| 30-day Hospital Readmission | Date of discharge (on average 6 to 7 days) to 30 days after discharge (on average 5 weeks) | New acute care hospitalization within 30-days of discharge from the index hospitalization |
Countries
Canada
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Preoperative Geriatric Consult or Assessment Patients who have a geriatric assessment of consult billed in the 4 months before surgery
Preoperative geriatric consult or assessment: A preoperative geriatric consult or assessment will be considered to be present if such a consult or assessment is billed by a geriatrician for a patient in the cohort within 4 months preceding surgery. For the primary analysis we will collapse both geriatric consultations and comprehensive geriatric assessments into a single exposure level. | 7,352 |
| No Preoperative Geriatric Consult or Assessment Patients who do not have a geriatric assessment of consult billed in the 4 months before surgery
No Preoperative geriatric consult or assessment: No assessment or consult billed in the 4 months before surgery | 259,147 |
| Total | 266,499 |
Baseline characteristics
| Characteristic | Preoperative Geriatric Consult or Assessment | No Preoperative Geriatric Consult or Assessment | Total |
|---|---|---|---|
| Age, Continuous | 75.0 years STANDARD_DEVIATION 6.3 | 74.2 years STANDARD_DEVIATION 6.2 | 74.6 years STANDARD_DEVIATION 6 |
| Neighbourhood Income Quintile | 3 Neighbourhood income quintile | 3 Neighbourhood income quintile | 3 Neighbourhood income quintile |
| Sex: Female, Male Female | 4400 Participants | 137096 Participants | 141496 Participants |
| Sex: Female, Male Male | 2952 Participants | 122051 Participants | 125003 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 103 / 7,352 | 6,172 / 259,147 |
| other Total, other adverse events | 0 / 0 | 0 / 0 |
| serious Total, serious adverse events | 0 / 0 | 0 / 0 |
Outcome results
Primary
Number of Participants With All-Cause Mortality at 90-days
Death from any cause in the 90 days after surgery
Time frame: date of surgery to 90 days after surgery
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Preoperative Geriatric Consult or Assessment | Number of Participants With All-Cause Mortality at 90-days | 103 Participants |
| No Preoperative Geriatric Consult or Assessment | Number of Participants With All-Cause Mortality at 90-days | 6172 Participants |
Secondary
30-day Hospital Readmission
New acute care hospitalization within 30-days of discharge from the index hospitalization
Time frame: Date of discharge (on average 6 to 7 days) to 30 days after discharge (on average 5 weeks)
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Preoperative Geriatric Consult or Assessment | 30-day Hospital Readmission | 643 Participants |
| No Preoperative Geriatric Consult or Assessment | 30-day Hospital Readmission | 20656 Participants |
Secondary
Hospital Length of Stay
Time frame: date of surgery to date of hospital discharge, or 365 days after surgery, whichever comes first
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Preoperative Geriatric Consult or Assessment | Hospital Length of Stay | 6.0 Days | Standard Deviation 7.3 |
| No Preoperative Geriatric Consult or Assessment | Hospital Length of Stay | 7.1 Days | Standard Deviation 10.3 |
Secondary
Non-independent Discharge Location
Discharge disposition from hospital record that is not a home discharge without support
Time frame: date of surgery to date of hospital discharge, or 365 days after surgery, whichever comes first
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Preoperative Geriatric Consult or Assessment | Non-independent Discharge Location | 5264 Participants |
| No Preoperative Geriatric Consult or Assessment | Non-independent Discharge Location | 145822 Participants |
Secondary
Patient Safety Event
Any Type 2 diagnostic code for a patient-safety event
Time frame: From surgery to hospital discharge (on average 6 to 7 days)
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Preoperative Geriatric Consult or Assessment | Patient Safety Event | 1129 Participants |
| No Preoperative Geriatric Consult or Assessment | Patient Safety Event | 50256 Participants |