Aged, Anti Cholinergics, Epidemiology, Length of Stay, Surgical Procedure, Operative
Conditions
Brief summary
This study investigates the association of preoperative anticholinergic medication exposure with 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 Anticholinergic Risk Scale and postoperative healthcare resource utilization. Sensitivity analyses will be used to evaluate the robustness of the primary analysis.
Interventions
OTHERanticholinergic risk scale
Risk summation scale for grading and studying anticholinergic medication exposure
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
* at least 66 years old on the day of surgery * Intermediate to high risk elective noncardiac surgery
Exclusion criteria
\-
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Hospital 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 |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| 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) |
| Mortality | from day of surgery up to 90 days after surgery | death from any cause |
| Hospital Readmission | From the date of hospital discharge to 30 days after the date of discharge | Acute hospital readmission after discharge from index hospitalization |
Countries
Canada
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| No Anticholinergic Exposure People with an anticholinergic risk scale score of 0 | 173,522 |
| Moderate Anticholinergic Exposure People with an anticholinergic risk scale score of 1-2
anticholinergic risk scale: Risk summation scale for grading and studying anticholinergic medication exposure | 38,127 |
| High Anticholinergic Exposure People with an anticholinergic risk scale score of \>=3
anticholinergic risk scale: Risk summation scale for grading and studying anticholinergic medication exposure | 33,327 |
| Total | 244,976 |
Baseline characteristics
| Characteristic | No Anticholinergic Exposure | Moderate Anticholinergic Exposure | High Anticholinergic Exposure | Total |
|---|---|---|---|---|
| Age, Continuous | 74 years STANDARD_DEVIATION 6 | 74 years STANDARD_DEVIATION 6 | 75 years STANDARD_DEVIATION 6 | 74 years STANDARD_DEVIATION 6 |
| Sex: Female, Male Female | 86587 Participants | 23257 Participants | 20063 Participants | 129907 Participants |
| Sex: Female, Male Male | 86935 Participants | 14870 Participants | 13264 Participants | 115069 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk |
|---|---|---|---|
| deaths Total, all-cause mortality | 3,515 / 173,522 | 1,154 / 38,127 | 939 / 33,327 |
| other Total, other adverse events | 0 / 0 | 0 / 0 | 0 / 0 |
| serious Total, serious adverse events | 0 / 0 | 0 / 0 | 0 / 0 |
Outcome results
Primary
Hospital 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 (MEAN) | Dispersion |
|---|---|---|---|
| No Anticholinergic Exposure | Hospital Length of Stay | 6.8 Days | Standard Deviation 9.7 |
| Moderate Anticholinergic Exposure | Hospital Length of Stay | 7.8 Days | Standard Deviation 11.4 |
| High Anticholinergic Exposure | Hospital Length of Stay | 7.5 Days | Standard Deviation 11.3 |
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 |
|---|---|---|---|
| No Anticholinergic Exposure | Costs of Care | 21528 Canadian Dollars | Standard Deviation 21645 |
| Moderate Anticholinergic Exposure | Costs of Care | 24108 Canadian Dollars | Standard Deviation 23342 |
| High Anticholinergic Exposure | Costs of Care | 24610 Canadian Dollars | Standard Deviation 24679 |
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) |
|---|---|---|
| No Anticholinergic Exposure | Hospital Readmission | 10905 Participants |
| Moderate Anticholinergic Exposure | Hospital Readmission | 2981 Participants |
| High Anticholinergic Exposure | Hospital Readmission | 2666 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) |
|---|---|---|
| No Anticholinergic Exposure | Institutional Discharge | 34724 Participants |
| Moderate Anticholinergic Exposure | Institutional Discharge | 8885 Participants |
| High Anticholinergic Exposure | Institutional Discharge | 7371 Participants |
Secondary
Mortality
death from any cause
Time frame: from day of surgery up to 90 days after surgery
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| No Anticholinergic Exposure | Mortality | 3515 Participants |
| Moderate Anticholinergic Exposure | Mortality | 1154 Participants |
| High Anticholinergic Exposure | Mortality | 939 Participants |