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This study investigates the association of preoperative polypharmacy with outcomes and healthcare resource utilization in a population-based sample of older patients enrolled in a universal pharmacare program
Multilevel multivariable regression analysis will be used to investigate the adjusted association between preoperative polypharmacy and postoperative outcomes and healthcare resource utilization. Sensitivity analyses will be used to evaluate the robustness of the primary analysis.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Polypharmacy | People taking >=5 unique prescription drugs in the 3 months prior to surgery |
| |
| No polypharmacy | People taking <5 unique prescription drugs in the 3 months prior to surgery |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Polypharmacy | Drug | Patients who are taking >=5 unique prescription drugs in the 3 months prior to surgery |
|
| Measure | Description | Time Frame |
|---|---|---|
| Mortality | death from any cause | from day of surgery up to 90 days after surgery |
| Measure | Description | Time Frame |
|---|---|---|
| Complications | Patient with a complication based on clusters of ICD-10 Type 2 codes collected in the hospital record | From day of surgery to day of hospital discharge, up to 365 days after surgery |
| Length of Stay |
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Inclusion Criteria:
Exclusion Criteria:
-
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Population-based sample of people having their first eligible surgery during the study period
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 29443701 | Derived | McIsaac DI, Wong CA, Bryson GL, van Walraven C. Association of Polypharmacy with Survival, Complications, and Healthcare Resource Use after Elective Noncardiac Surgery: A Population-based Cohort Study. Anesthesiology. 2018 Jun;128(6):1140-1150. doi: 10.1097/ALN.0000000000002124. |
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| ID | Title | Description |
|---|---|---|
| FG000 | Polypharmacy | People taking >=5 unique prescription drugs in the 3 months prior to surgery Polypharmacy: Patients who are taking >=5 unique prescription drugs in the 3 months prior to surgery |
| FG001 | No Polypharmacy | People taking <5 unique prescription drugs in the 3 months prior to surgery |
| Title | Milestones | Reasons Not Completed | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Overall Study |
|
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| ID | Title | Description |
|---|---|---|
| BG000 | Polypharmacy | People taking >=5 unique prescription drugs in the 3 months prior to surgery Polypharmacy: Patients who are taking >=5 unique prescription drugs in the 3 months prior to surgery |
| BG001 | No Polypharmacy |
| Units | Counts |
|---|---|
| Participants |
|
| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes |
|---|---|---|---|---|---|---|---|---|---|
| Age, Continuous | Mean |
| 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 | Mortality | death from any cause | Posted | Count of Participants | Participants | from day of surgery up to 90 days after surgery |
|
Within 90 days of surgery
All-Cause Mortality: The occurrence of death due to any cause.
No other adverse events were monitored or reported.
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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 | Polypharmacy | People taking >=5 unique prescription drugs in the 3 months prior to surgery Polypharmacy: Patients who are taking >=5 unique prescription drugs in the 3 months prior to surgery |
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We are unable to fully account for unmeasured confounders and indication bias. We were not able to account for granular patient-level data. We used health administrative data that were not initially collected for research purposes; risk of misclassification bias should be considered. Our polypharmacy exposure did not account for the potential differing risk impacts or appropriateness of different drugs. We were unable to account for medication underutilization which could bias results.
| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Dr. Daniel McIsaac | The Ottawa Hospital | 613-761-4940 | dmcisaac@toh.ca |
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| ID | Term |
|---|---|
| D019338 | Polypharmacy |
| ID | Term |
|---|---|
| D004358 | Drug Therapy |
| D013812 | Therapeutics |
| D000088922 | Overtreatment |
| D000069342 | Medical Overuse |
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Number of days in hospital after surgery
| date of surgery to date of hospital discharge, or 365 days after surgery, whichever comes first |
| Costs of Care | Costs related to medical care paid for by the provincial health insurance system | date of surgery up to 90 days after surgery |
| Institutional Discharge | A discharge location at the end of the surgical episode of care that is not back to the patient's original residence (specifically respite or long term care) | date of surgery to date of hospital discharge, or 365 days after surgery, whichever comes first |
| Hospital Readmission | Acute hospital readmission after discharge from index hospitalization | From the date of hospital discharge to 30 days after the date of discharge |
People taking <5 unique prescription drugs in the 3 months prior to surgery
| BG002 | Total | Total of all reporting groups |
| years |
|
| Sex: Female, Male | Count of Participants | Participants |
|
| 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 | Income group |
|
| Units |
|---|
| Counts |
|---|
| Participants |
|
|
| Secondary | Complications | Patient with a complication based on clusters of ICD-10 Type 2 codes collected in the hospital record | Posted | Count of Participants | Participants | From day of surgery to day of hospital discharge, up to 365 days after surgery |
|
|
|
| Secondary | Length of Stay | Number of days in hospital after surgery | Posted | Median | Inter-Quartile Range | Days | date of surgery to date of hospital discharge, or 365 days after surgery, whichever comes first |
|
|
|
| Secondary | Costs of Care | Costs related to medical care paid for by the provincial health insurance system | Posted | Mean | Standard Deviation | Canadian Dollars | date of surgery up to 90 days after surgery |
|
|
|
| Secondary | Institutional Discharge | A discharge location at the end of the surgical episode of care that is not back to the patient's original residence (specifically respite or long term care) | Posted | Count of Participants | Participants | date of surgery to date of hospital discharge, or 365 days after surgery, whichever comes first |
|
|
|
| Secondary | Hospital Readmission | Acute hospital readmission after discharge from index hospitalization | Posted | Count of Participants | Participants | From the date of hospital discharge to 30 days after the date of discharge |
|
|
|
| 4,356 |
| 146,029 |
| 0 |
| 0 |
| 0 |
| 0 |
| EG001 | No Polypharmacy | People taking <5 unique prescription drugs in the 3 months prior to surgery | 1,919 | 120,470 | 0 | 0 | 0 | 0 |
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| D006300 |
| Health Services Misuse |
| D006296 | Health Services |
| D005159 | Health Care Facilities Workforce and Services |
| D001294 | Attitude to Health |
| D003695 | Delivery of Health Care |
| D017530 | Health Care Quality, Access, and Evaluation |