Frail Elderly Syndrome, Surgery, Outcomes, Predictive Value of Tests
Conditions
Brief summary
The investigators will create a frailty index using health administrative data available for older people having surgery. The index will be based on the Canadian Study of Health and Aging Frailty Index and standard recommendations for creation of frailty indices.
Detailed description
The investigators will create a frailty index using health administrative data available for older people having surgery. The index will be based on the Canadian Study of Health and Aging Frailty Index and standard recommendations for creation of frailty indices. Once derived the index will be tested to measure its association with outcomes, as well as its discrimination. Various representations of the frailty index will be tested (primary-as a continuous measure; secondary as a binary, categorical and fractional polynomial variable). Performance in subgroups will also be evaluated,
Interventions
DIAGNOSTIC_TESTFrailty index
A frailty index composed of variables from health administrative data that cover multi-system health issues. Deficits will be coded as present or absent, and the number of deficits present will be divided by the total number of deficits present to provide an overall score between 0-1.
Sponsors
Ottawa Hospital Research Institute
Study design
Observational model
COHORT
Time perspective
RETROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
66 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Having elective or emergency noncardiac surgery
Exclusion criteria
* no provincial health insurance number
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Survival for One Year After Surgery | Date of surgery to 365 days after surgery | Still being alive (no death date) in the registered persons database Outcome is binary, exposure is per 0.1 unit increase |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Institutional Discharge | Date of surgery to date of hospital discharge, or up to one year after surgery (whichever comes first) | Discharge to long term care or continuing care facility at the time of hospital discharge |
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Elective Surgery Individuals having major noncardiac surgery following an elective hospital admission
Frailty index: A frailty index composed of variables from health administrative data that cover multi-system health issues. Deficits will be coded as present or absent, and the number of deficits present will be divided by the total number of deficits present to provide an overall score between 0-1. | 415,704 |
| Emergency Surgery Individuals having general surgery following an urgent hospital admission
Frailty index: A frailty index composed of variables from health administrative data that cover multi-system health issues. Deficits will be coded as present or absent, and the number of deficits present will be divided by the total number of deficits present to provide an overall score between 0-1. | 95,581 |
| Total | 511,285 |
Baseline characteristics
| Characteristic | Elective Surgery | Emergency Surgery | Total |
|---|---|---|---|
| Age, Continuous Frail | 76 years STANDARD_DEVIATION 6 | 76 years STANDARD_DEVIATION 6 | 76 years STANDARD_DEVIATION 6 |
| Age, Continuous Not Frail | 73 years STANDARD_DEVIATION 6 | 73 years STANDARD_DEVIATION 6 | 73 years STANDARD_DEVIATION 6 |
| Sex: Female, Male Frail Female | 58953 Participants | 21420 Participants | 80373 Participants |
| Sex: Female, Male Frail Male | 60871 Participants | 18618 Participants | 79489 Participants |
| Sex: Female, Male Not Frail Female | 165693 Participants | 30493 Participants | 196186 Participants |
| Sex: Female, Male Not Frail Male | 130187 Participants | 25050 Participants | 155237 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 19,540 / 415,704 | 0 / 0 |
| other Total, other adverse events | 0 / 0 | 0 / 0 |
| serious Total, serious adverse events | 0 / 0 | 0 / 0 |
Outcome results
Primary
Survival for One Year After Surgery
Still being alive (no death date) in the registered persons database Outcome is binary, exposure is per 0.1 unit increase
Time frame: Date of surgery to 365 days after surgery
Population: We measured the unadjusted and adjusted associations between the pFI and postoperative outcomes in our elective surgery cohort. The unadjusted analysis contained only the pFI. Data was not collected from Emergency Surgery patients.
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Elective Surgery | Survival for One Year After Surgery | 396164 Participants |
| Emergency Surgery | Survival for One Year After Surgery | 0 Participants |
Secondary
Institutional Discharge
Discharge to long term care or continuing care facility at the time of hospital discharge
Time frame: Date of surgery to date of hospital discharge, or up to one year after surgery (whichever comes first)
Population: We measured the unadjusted and adjusted associations between the pFI and postoperative outcomes in our elective surgery cohort. The unadjusted analysis contained only the pFI. Data not collected from Emergency Surgery patients.
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Elective Surgery | Institutional Discharge | 57666 Participants |
| Emergency Surgery | Institutional Discharge | 0 Participants |