Having ≤8 days at home up to 30 days after surgery was associated with a higher risk of death up to 1 year postoperatively compared with 29-30 days at home (adjusted HR 6.78; 95% CI 6.44-7.13).
Cohort (n=636,885)
Yes
Effect estimate: adjusted HR 6.78 (95% CI 6.44-7.13)
BACKGROUND: , as a surgical outcome measure in clinical trials and quality assurance. METHODS: This was a multicentre, registry-based cohort study. We used prospectively collected hospital and national healthcare registry data obtained from patients aged 18 years or older undergoing a broad range of surgeries in Sweden over a 10-year period. The association between days at home up to 30 days after surgery and patient (older age, poorer physical status, comorbidity) and surgical (elective or non-elective, complexity, duration) risk factors, process of care outcomes (re-admissions, discharge destination), clinical outcomes (major complications, 30-day mortality) and death up to 1 year after surgery were measured. FINDINGS: From January, 2005, to December, 2014, we obtained demographic and perioperative data on 636,885 patients from 21 Swedish hospitals. Mortality at 30 days and one year was 1.8% and 7.3%, respectively. The median (IQR) days at home up to 30 days after surgery was 27 (23-29), being significantly lower among high-risk patients, those recovering from more complex surgical procedures, and suffering serious postoperative complications (all p < 0.0001). Patients with 8 days or less at home up to 30 days after surgery had a nearly 7-fold higher risk of death up to 1 year postoperatively when compared with those with 29 or 30 days at home (adjusted HR 6.78 95% CI: 6.44-7.13). INTERPRETATION: Days at home up to 30 days after surgery is a valid, easy to measure patient-centred outcome metric. It is highly sensitive to changes in surgical risk and impact of complications, and has prognostic importance; it is therefore a valuable endpoint for perioperative clinical trials and quality assurance. FUNDING: Swedish National Research Council Medicine and Stockholm County Council ALF-project grant (LE), and the Australian National Health and Medical Research Council (PM).
Bell et al. (Sat,) conducted a cohort in Surgery (n=636,885). ≤8 days at home up to 30 days after surgery vs. 29 or 30 days at home was evaluated on Death up to 1 year after surgery (adjusted HR 6.78, 95% CI 6.44-7.13). Having ≤8 days at home up to 30 days after surgery was associated with a higher risk of death up to 1 year postoperatively compared with 29-30 days at home (adjusted HR 6.78; 95% CI 6.44-7.13).