Postoperative Complications
Conditions
Brief summary
This retrospective, population-based cohort study will evaluate the comparative effectiveness of peripheral nerve blocks on patient outcomes after ambulatory shoulder surgery in adults patients undergoing surgery in Ontario.
Detailed description
First, investigators will validate health administrative data codes to demonstrate the accuracy of Ontario-wide anesthesia type and regional anesthesia interventions using a reference standard (Ottawa Hospital Data Warehouse data). Then, these validated exposures, in combination with validated outcome measures, will be used to examine the impact of anesthesia interventions on patient and health system outcomes for ambulatory shoulder surgery.
Interventions
PROCEDUREIsolated General Anesthesia
No nerve block identified through physician billing codes
PROCEDUREPeripheral Nerve Block
Nerve block identified through physician billing codes
Sponsors
Ottawa Hospital Research Institute
Study design
Observational model
COHORT
Time perspective
RETROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Inclusion criteria
* Ontario residents * Aged 18 years and older * Elective ambulatory shoulder surgery performed in Ontario between April 2009 and December 2016.
Exclusion criteria
* Emergency Surgery * If a patient undergoes multiple elective shoulder surgeries within the time period, only the first surgery will be included for any participant in the study period.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Postoperative Death, Admission, Readmission or Emergency Department Visits | Date of surgery to 7 days (ED visits) and 30 days (readmissions) after surgery or death date, whichever came first | Composite outcome of: 1) unplanned admissions on the day of surgery , 2) post-discharge emergency department visits within 7 days of surgery, 3) readmission within 30 days of surgery, and 4) death from any cause |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Health System Costs | Date of surgery to 7 days and 30 days after surgery or death date, whichever came first | Costs in Canadian dollars will be calculated using standardized patient-level costing algorithms. |
| Neurology Consultations or Diagnostics | Date of surgery to 90 days after surgery or death date, whichever came first | Occurrence of neurology consult and/or nerve conduction study |
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Isolated General Anesthesia Ontario residents, aged 18 years and older, who have undergone elective ambulatory shoulder surgery in Ontario and have not had a nerve block identified using physician billing codes.
Isolated General Anesthesia: No nerve block identified through physician billing codes | 28,571 |
| Peripheral Nerve Block Ontario residents, aged 18 years and older, who have undergone elective ambulatory shoulder surgery in Ontario and have a nerve block identified using physician billing codes.
Peripheral Nerve Block: Nerve block identified through physician billing codes | 31,073 |
| Total | 59,644 |
Baseline characteristics
| Characteristic | Isolated General Anesthesia | Peripheral Nerve Block | Total |
|---|---|---|---|
| Age, Continuous | 51 years STANDARD_DEVIATION 13 | 52 years STANDARD_DEVIATION 12 | 51 years STANDARD_DEVIATION 12 |
| Healthcare resource use Emergency department visit in the last year | 12543 Participants | 12181 Participants | 24724 Participants |
| Healthcare resource use Hospitalization in the last year | 1657 Participants | 1523 Participants | 3180 Participants |
| Neighbourhood Income Quintile | 3 Neighbourhood income quintile | 3 Neighbourhood income quintile | 3 Neighbourhood income quintile |
| Rural | 5343 Participants | 4039 Participants | 9382 Participants |
| Sex: Female, Male Female | 9343 Participants | 10534 Participants | 19877 Participants |
| Sex: Female, Male Male | 19228 Participants | 20539 Participants | 39767 Participants |
| Surgery Type Arthroscopic | 20314 Participants | 23584 Participants | 43898 Participants |
| Surgery Type Open | 8257 Participants | 7489 Participants | 15746 Participants |
| Surgery Type Other shoulder repair | 343 Participants | 124 Participants | 467 Participants |
| Surgery Type Rotator cuff repair | 16571 Participants | 19607 Participants | 36178 Participants |
| Surgery Type Shoulder arthroplasty or joint repair | 11657 Participants | 11342 Participants | 22999 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 0 / 0 | 0 / 0 |
| other Total, other adverse events | 0 / 0 | 0 / 0 |
| serious Total, serious adverse events | 0 / 0 | 0 / 0 |
Outcome results
Primary
Postoperative Death, Admission, Readmission or Emergency Department Visits
Composite outcome of: 1) unplanned admissions on the day of surgery , 2) post-discharge emergency department visits within 7 days of surgery, 3) readmission within 30 days of surgery, and 4) death from any cause
Time frame: Date of surgery to 7 days (ED visits) and 30 days (readmissions) after surgery or death date, whichever came first
Population: Primary analysis
| Arm | Measure | Group | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| Isolated General Anesthesia | Postoperative Death, Admission, Readmission or Emergency Department Visits | Unplanned admission | 1,784 Participants |
| Isolated General Anesthesia | Postoperative Death, Admission, Readmission or Emergency Department Visits | Readmission within 30 days | 85 Participants |
| Isolated General Anesthesia | Postoperative Death, Admission, Readmission or Emergency Department Visits | ED visits within 7 days | 1,779 Participants |
| Isolated General Anesthesia | Postoperative Death, Admission, Readmission or Emergency Department Visits | Composite outcome | 3,424 Participants |
| Peripheral Nerve Block | Postoperative Death, Admission, Readmission or Emergency Department Visits | Composite outcome | 2,808 Participants |
| Peripheral Nerve Block | Postoperative Death, Admission, Readmission or Emergency Department Visits | Unplanned admission | 1,132 Participants |
| Peripheral Nerve Block | Postoperative Death, Admission, Readmission or Emergency Department Visits | ED visits within 7 days | 1,732 Participants |
| Peripheral Nerve Block | Postoperative Death, Admission, Readmission or Emergency Department Visits | Readmission within 30 days | 98 Participants |
Secondary
Health System Costs
Costs in Canadian dollars will be calculated using standardized patient-level costing algorithms.
Time frame: Date of surgery to 7 days and 30 days after surgery or death date, whichever came first
| Arm | Measure | Group | Value (MEAN) |
|---|---|---|---|
| Isolated General Anesthesia | Health System Costs | Cost after surgery (7 days) | 4,391 Canadian Dollars |
| Isolated General Anesthesia | Health System Costs | Cost after surgery (30 days) | 4528 Canadian Dollars |
| Peripheral Nerve Block | Health System Costs | Cost after surgery (7 days) | 4681 Canadian Dollars |
| Peripheral Nerve Block | Health System Costs | Cost after surgery (30 days) | 4840 Canadian Dollars |
Secondary
Neurology Consultations or Diagnostics
Occurrence of neurology consult and/or nerve conduction study
Time frame: Date of surgery to 90 days after surgery or death date, whichever came first
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Isolated General Anesthesia | Neurology Consultations or Diagnostics | Nerve conduction studies in the 90 days after surgery | 235 Visits | Standard Deviation 0.8 |
| Isolated General Anesthesia | Neurology Consultations or Diagnostics | Neurology consultations in the 90 days after surgery | 74 Visits | Standard Deviation 0.3 |
| Peripheral Nerve Block | Neurology Consultations or Diagnostics | Neurology consultations in the 90 days after surgery | 92 Visits | Standard Deviation 0.3 |
| Peripheral Nerve Block | Neurology Consultations or Diagnostics | Nerve conduction studies in the 90 days after surgery | 274 Visits | Standard Deviation 0.9 |