Days at home after surgery reveal long-term outcome
Number-of-days-at-home within 30 days after surgery (DAH30) is a patient-centred outcome metrics that integrates length of hospital stay and any readmission or death within 30 days after a surgical procedure.
A group of clinical scientists at Karolinska Institutet, Sweden, and Monash University Melbourne, Australia, have now comprehensively evaluated DAH30 as a novel perioperative outcome metrics by combining unique information from an array of national health registries and data bases across Sweden.
The overall coverage of the health care registries in Sweden allowed the researchers to characterise preoperative comorbidities, differences in care processes, patient and surgical risk factors with great accuracy. Morever, they could extract high resolution information on process of care outcomes, clinical outcomes and long-term mortality. The results are published in the journal EClinicalMedicine.
In this study of more than 630.000 adult patients undergoing either elective or acute surgery, the number of postoperative days at home up to 30 days after surgery was closely associated with surgical risk and postoperative outcomes. This included process of care outcomes, perioperative complications and the metric was associated with mortality up to 1 year after surgery. In addition, the study showed that DAH30 can serve as an ideal, patient-centred outcome measure for perioperative clinical trials and quality assurance. In this context, DAH30 provides greater statistical power and could reduce the number of patients needed for clinical trials.
“With more than 10 percent of the population in industrialized countries undergoing surgery and anaesthesia each year, quality improvement and safety within perioperative care has a major impact, not only for the individual patient and their families, but for the health care system and society”, said study co-author Lars I. Eriksson, a Professor of Anesthesiology and Intensive Care Medicine at the Department of Physiology and Pharmacology, Karolinska Institutet, and also Senior Physician at the Karolinska University Hospital in Stockholm, Sweden.
The scientists underscores that the development of surgery and anaesthesia have steadily reduced perioperative complications, increased patient satisfaction and improved health care costs. And while outcome measures after surgery typically focuses on perioperative complications, a more comprehensive outcome metric after surgery should ideally capture meaningful care deviations and recovery after surgery providing a more relevant measurement of patient experience.
Corresponding author of this study is Professor Paul Myles of Monash University, Australia. The study is funded by the Stockholm Region in Sweden, the Australian National Health and Medical Research Council Practitioner Fellowship, and the Australian Government Research Training Program Scholarship.
Days at Home after Surgery: An Integrated and Efficient Outcome Measure for Clinical Trials and Quality Assurance
Max Bell, Lars I. Eriksson, Tobias Svensson, Linn Hallqvist, Fredrik Granath, Jennifer Reilly, Paul S. Myles
The Lancet, 26 April 2019