Epidemiology, Morality, Polypharmacy, Surgical Procedure, Operative
Conditions
Brief summary
This study investigates the association of preoperative polypharmacy with outcomes and healthcare resource utilization in a population-based sample of older patients enrolled in a universal pharmacare program
Detailed description
Multilevel multivariable regression analysis will be used to investigate the adjusted association between preoperative polypharmacy and postoperative outcomes and healthcare resource utilization. Sensitivity analyses will be used to evaluate the robustness of the primary analysis.
Interventions
DRUGPolypharmacy
Patients who are taking \>=5 unique prescription drugs in the 3 months prior to 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
* Intermediate to high risk elective non-cardiac surgery * Age \>=66 on day of surgery
Exclusion criteria
\-
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Mortality | from day of surgery up to 90 days after surgery | death from any cause |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Complications | From day of surgery to day of hospital discharge, up to 365 days after surgery | Patient with a complication based on clusters of ICD-10 Type 2 codes collected in the hospital record |
| Length of Stay | date of surgery to date of hospital discharge, or 365 days after surgery, whichever comes first | Number of days in hospital after surgery |
| Costs of Care | date of surgery up to 90 days after surgery | Costs related to medical care paid for by the provincial health insurance system |
| Institutional Discharge | date of surgery to date of hospital discharge, or 365 days after surgery, whichever comes first | A discharge location at the end of the surgical episode of care that is not back to the patient's original residence (specifically respite or long term care) |
| Hospital Readmission | From the date of hospital discharge to 30 days after the date of discharge | Acute hospital readmission after discharge from index hospitalization |
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Polypharmacy People taking \>=5 unique prescription drugs in the 3 months prior to surgery
Polypharmacy: Patients who are taking \>=5 unique prescription drugs in the 3 months prior to surgery | 146,029 |
| No Polypharmacy People taking \<5 unique prescription drugs in the 3 months prior to surgery | 120,470 |
| Total | 266,499 |
Baseline characteristics
| Characteristic | Polypharmacy | No Polypharmacy | Total |
|---|---|---|---|
| Age, Continuous | 75 years STANDARD_DEVIATION 6 | 73 years STANDARD_DEVIATION 6 | 74 years STANDARD_DEVIATION 6 |
| Income quintile | 3 Income group | 3 Income group | 3 Income group |
| Sex: Female, Male Female | 81922 Participants | 59512 Participants | 141434 Participants |
| Sex: Female, Male Male | 64107 Participants | 60958 Participants | 125065 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 4,356 / 146,029 | 1,919 / 120,470 |
| other Total, other adverse events | 0 / 0 | 0 / 0 |
| serious Total, serious adverse events | 0 / 0 | 0 / 0 |
Outcome results
Primary
Mortality
death from any cause
Time frame: from day of surgery up to 90 days after surgery
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Polypharmacy | Mortality | 4356 Participants |
| No Polypharmacy | Mortality | 1919 Participants |
Secondary
Complications
Patient with a complication based on clusters of ICD-10 Type 2 codes collected in the hospital record
Time frame: From day of surgery to day of hospital discharge, up to 365 days after surgery
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Polypharmacy | Complications | 31570 Participants |
| No Polypharmacy | Complications | 19815 Participants |
Secondary
Costs of Care
Costs related to medical care paid for by the provincial health insurance system
Time frame: date of surgery up to 90 days after surgery
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Polypharmacy | Costs of Care | 24064 Canadian Dollars | Standard Deviation 16624 |
| No Polypharmacy | Costs of Care | 20251 Canadian Dollars | Standard Deviation 24424 |
Secondary
Hospital Readmission
Acute hospital readmission after discharge from index hospitalization
Time frame: From the date of hospital discharge to 30 days after the date of discharge
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Polypharmacy | Hospital Readmission | 13202 Participants |
| No Polypharmacy | Hospital Readmission | 8097 Participants |
Secondary
Institutional Discharge
A discharge location at the end of the surgical episode of care that is not back to the patient's original residence (specifically respite or long term care)
Time frame: date of surgery to date of hospital discharge, or 365 days after surgery, whichever comes first
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Polypharmacy | Institutional Discharge | 34128 Participants |
| No Polypharmacy | Institutional Discharge | 23098 Participants |
Secondary
Length of Stay
Number of days in hospital after surgery
Time frame: date of surgery to date of hospital discharge, or 365 days after surgery, whichever comes first
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Polypharmacy | Length of Stay | 5 Days |
| No Polypharmacy | Length of Stay | 5 Days |