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This study investigates the association of preoperative anticholinergic medication exposure with 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 Anticholinergic Risk Scale and postoperative 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 |
|---|---|---|---|
| No anticholinergic exposure | People with an anticholinergic risk scale score of 0 | ||
| Moderate anticholinergic exposure | People with an anticholinergic risk scale score of 1-2 |
| |
| High anticholinergic exposure | People with an anticholinergic risk scale score of >=3 |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| anticholinergic risk scale | Other | Risk summation scale for grading and studying anticholinergic medication exposure |
|
| Measure | Description | Time Frame |
|---|---|---|
| Hospital Length of Stay | Number of days in hospital after surgery | date of surgery to date of hospital discharge, or 365 days after surgery, whichever comes first |
| Measure | Description | Time Frame |
|---|---|---|
| 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) |
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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
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Ottawa Hospital Research Institute | Ottawa | Ontario | K1Y4E9 | Canada |
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| ID | Title | Description |
|---|---|---|
| FG000 | No Anticholinergic Exposure | People with an anticholinergic risk scale score of 0 |
| FG001 | Moderate Anticholinergic Exposure | People with an anticholinergic risk scale score of 1-2 anticholinergic risk scale: Risk summation scale for grading and studying anticholinergic medication exposure |
| FG002 | High Anticholinergic Exposure | People with an anticholinergic risk scale score of >=3 anticholinergic risk scale: Risk summation scale for grading and studying anticholinergic medication exposure |
| Title | Milestones | Reasons Not Completed | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Overall Study |
|
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| ID | Title | Description |
|---|---|---|
| BG000 | No Anticholinergic Exposure | People with an anticholinergic risk scale score of 0 |
| BG001 | Moderate Anticholinergic Exposure | People with an anticholinergic risk scale score of 1-2 anticholinergic risk scale: Risk summation scale for grading and studying anticholinergic medication exposure |
| 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 | Hospital Length of Stay | Number of days in hospital after surgery | Posted | Mean | Standard Deviation | Days | date of surgery to date of hospital discharge, or 365 days after surgery, whichever comes first |
|
1 year
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 | No Anticholinergic Exposure | People with an anticholinergic risk scale score of 0 |
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The data used were not initially collected for research purposes and could be subject to misclassification bias. Our findings are at risk of unmeasured confounding. Administrative data do not accurately capture delirium, so we were unable to provide estimates of the association of the ARS with delirium rates. We chose to use the ARS as our measure of anticholinergic exposure; however, several anticholinergic scales have been described and effect sizes vary.
| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Dr. Daniel McIsaac | The Ottawa Hospital | 613-761-4940 | dmcisaac@toh.ca |
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| date of surgery to date of hospital discharge, or 365 days after surgery, whichever comes first |
| Mortality | death from any cause | from day of surgery up to 90 days after surgery |
| Hospital Readmission | Acute hospital readmission after discharge from index hospitalization | From the date of hospital discharge to 30 days after the date of discharge |
| BG002 | High Anticholinergic Exposure | People with an anticholinergic risk scale score of >=3 anticholinergic risk scale: Risk summation scale for grading and studying anticholinergic medication exposure |
| BG003 | Total | Total of all reporting groups |
| years |
|
| Sex: Female, Male | Count of Participants | Participants |
|
People with an anticholinergic risk scale score of >=3 anticholinergic risk scale: Risk summation scale for grading and studying anticholinergic medication exposure |
|
|
| 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 | Mortality | death from any cause | Posted | Count of Participants | Participants | from day of surgery up to 90 days after surgery |
|
|
|
| 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 |
|
|
|
| 3,515 |
| 173,522 |
| 0 |
| 0 |
| 0 |
| 0 |
| EG001 | Moderate Anticholinergic Exposure | People with an anticholinergic risk scale score of 1-2 anticholinergic risk scale: Risk summation scale for grading and studying anticholinergic medication exposure | 1,154 | 38,127 | 0 | 0 | 0 | 0 |
| EG002 | High Anticholinergic Exposure | People with an anticholinergic risk scale score of >=3 anticholinergic risk scale: Risk summation scale for grading and studying anticholinergic medication exposure | 939 | 33,327 | 0 | 0 | 0 | 0 |
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