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The investigators will conduct a population-based study using health administrative data to evaluate the impact of preoperative geriatric consultation on postoperative outcomes in older patients having elective, non-cardiac surgery
The investigators will use multilevel multivariable analyses to measure the association between preoperative geriatric assessment or consultation and outcomes after major elective non-cardiac surgery. Sensitivity analyses will be done to evaluate types and timing of geriatric care around surgery, as well as for effect modification based on patient and procedural factors.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Preoperative geriatric consult or assessment | Patients who have a geriatric assessment of consult billed in the 4 months before surgery |
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| No Preoperative geriatric consult or assessment | Patients who do not have a geriatric assessment of consult billed in the 4 months before surgery |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Preoperative geriatric consult or assessment | Procedure | A preoperative geriatric consult or assessment will be considered to be present if such a consult or assessment is billed by a geriatrician for a patient in the cohort within 4 months preceding surgery. For the primary analysis we will collapse both geriatric consultations and comprehensive geriatric assessments into a single exposure level. |
| Measure | Description | Time Frame |
|---|---|---|
| Number of Participants With All-Cause Mortality at 90-days | Death from any cause in the 90 days after surgery | date of surgery to 90 days after surgery |
| Measure | Description | Time Frame |
|---|---|---|
| Patient Safety Event | Any Type 2 diagnostic code for a patient-safety event | From surgery to hospital discharge (on average 6 to 7 days) |
| Hospital Length of Stay | date of surgery to date of hospital discharge, or 365 days after surgery, whichever comes first |
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Inclusion Criteria:
Exclusion Criteria:
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Individuals >65 years of age on the day of the potential participant's first elective non-cardiac surgery in the study period
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Ottawa Hospital Research Institute | Ottawa | Ontario | K1Y 4E9 | Canada |
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| ID | Title | Description |
|---|---|---|
| FG000 | Preoperative Geriatric Consult or Assessment | Patients who have a geriatric assessment of consult billed in the 4 months before surgery Preoperative geriatric consult or assessment: A preoperative geriatric consult or assessment will be considered to be present if such a consult or assessment is billed by a geriatrician for a patient in the cohort within 4 months preceding surgery. For the primary analysis we will collapse both geriatric consultations and comprehensive geriatric assessments into a single exposure level. |
| Title | Milestones | Reasons Not Completed | |||||
|---|---|---|---|---|---|---|---|
| Overall Study |
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| No Preoperative geriatric consult or assessment | Procedure | No assessment or consult billed in the 4 months before surgery |
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| Non-independent Discharge Location | Discharge disposition from hospital record that is not a home discharge without support | date of surgery to date of hospital discharge, or 365 days after surgery, whichever comes first |
| 30-day Hospital Readmission | New acute care hospitalization within 30-days of discharge from the index hospitalization | Date of discharge (on average 6 to 7 days) to 30 days after discharge (on average 5 weeks) |
| FG001 | No Preoperative Geriatric Consult or Assessment | Patients who do not have a geriatric assessment of consult billed in the 4 months before surgery No Preoperative geriatric consult or assessment: No assessment or consult billed in the 4 months before surgery |
| COMPLETED |
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| NOT COMPLETED |
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| ID | Title | Description |
|---|---|---|
| BG000 | Preoperative Geriatric Consult or Assessment | Patients who have a geriatric assessment of consult billed in the 4 months before surgery Preoperative geriatric consult or assessment: A preoperative geriatric consult or assessment will be considered to be present if such a consult or assessment is billed by a geriatrician for a patient in the cohort within 4 months preceding surgery. For the primary analysis we will collapse both geriatric consultations and comprehensive geriatric assessments into a single exposure level. |
| BG001 | No Preoperative Geriatric Consult or Assessment | Patients who do not have a geriatric assessment of consult billed in the 4 months before surgery No Preoperative geriatric consult or assessment: No assessment or consult billed in the 4 months before surgery |
| BG002 | Total | Total of all reporting groups |
| Units | Counts |
|---|---|
| Participants |
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| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Age, Continuous | Mean | Standard Deviation | years |
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| Sex: Female, Male | Count of Participants | Participants |
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| Neighbourhood Income Quintile | Neighborhood socioeconomic status of the participants is presented as income quintile (income quintile is a measure of neighbourhood socioeconomic status that divides the population into five income groups (from lowest income to highest income)). The scale is from 1-5 (income group quintile 1 (lowest), 2, 3, 4, 5 (highest)). The groups are based on where 20% of the population falls within each category and therefore values vary by year. | Median | Inter-Quartile Range | Neighbourhood income quintile |
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| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | Number of Participants With All-Cause Mortality at 90-days | Death from any cause in the 90 days after surgery | Posted | Count of Participants | Participants | date of surgery to 90 days after surgery |
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| Secondary | Patient Safety Event | Any Type 2 diagnostic code for a patient-safety event | Posted | Count of Participants | Participants | From surgery to hospital discharge (on average 6 to 7 days) |
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| Secondary | Hospital Length of Stay | Posted | Mean | Standard Deviation | Days | date of surgery to date of hospital discharge, or 365 days after surgery, whichever comes first |
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| Secondary | Non-independent Discharge Location | Discharge disposition from hospital record that is not a home discharge without support | Posted | Count of Participants | Participants | date of surgery to date of hospital discharge, or 365 days after surgery, whichever comes first |
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| Secondary | 30-day Hospital Readmission | New acute care hospitalization within 30-days of discharge from the index hospitalization | Posted | Count of Participants | Participants | Date of discharge (on average 6 to 7 days) to 30 days after discharge (on average 5 weeks) |
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90 Days
All cause mortality: the occurrence of death due to any cause was collected. No other adverse events were collected.
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | Preoperative Geriatric Consult or Assessment | Patients who have a geriatric assessment of consult billed in the 4 months before surgery Preoperative geriatric consult or assessment: A preoperative geriatric consult or assessment will be considered to be present if such a consult or assessment is billed by a geriatrician for a patient in the cohort within 4 months preceding surgery. For the primary analysis we will collapse both geriatric consultations and comprehensive geriatric assessments into a single exposure level. | 103 | 7,352 | 0 | 0 | 0 | 0 |
| EG001 | No Preoperative Geriatric Consult or Assessment | Patients who do not have a geriatric assessment of consult billed in the 4 months before surgery No Preoperative geriatric consult or assessment: No assessment or consult billed in the 4 months before surgery | 6,172 | 259,147 | 0 | 0 | 0 | 0 |
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This was an observational study, so we cannot prove causality. Unmeasured confounding is a risk to causal inference, but we were able to control for a large number of confounders, including mortality risk, diagnoses, preoperative healthcare use, and unmeasured hospital-level confounders. We were unable to study all possible pathways, such as improvements in medication appropriateness, that may be attributable to geriatric care.
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| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Dr. Daniel McIsaac | The Ottawa Hospital | 613-761-4940 | dmcisaac@toh.ca |
| ID | Term |
|---|---|
| D012149 | Restraint, Physical |
| ID | Term |
|---|---|
| D032763 | Behavior Control |
| D013812 | Therapeutics |
| D007103 | Immobilization |
| D008919 | Investigative Techniques |
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| Male |
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