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The investigators will create a frailty index using health administrative data available for older people having surgery. The index will be based on the Canadian Study of Health and Aging Frailty Index and standard recommendations for creation of frailty indices.
The investigators will create a frailty index using health administrative data available for older people having surgery. The index will be based on the Canadian Study of Health and Aging Frailty Index and standard recommendations for creation of frailty indices.
Once derived the index will be tested to measure its association with outcomes, as well as its discrimination. Various representations of the frailty index will be tested (primary-as a continuous measure; secondary as a binary, categorical and fractional polynomial variable). Performance in subgroups will also be evaluated,
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Elective noncardiac surgery | Individuals having major noncardiac surgery following an elective hospital admission |
| |
| Emergency general surgery | Individuals having general surgery following an urgent hospital admission |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Frailty index | Diagnostic Test | A frailty index composed of variables from health administrative data that cover multi-system health issues. Deficits will be coded as present or absent, and the number of deficits present will be divided by the total number of deficits present to provide an overall score between 0-1. |
| Measure | Description | Time Frame |
|---|---|---|
| Survival for One Year After Surgery | Still being alive (no death date) in the registered persons database Outcome is binary, exposure is per 0.1 unit increase | Date of surgery to 365 days after surgery |
| Measure | Description | Time Frame |
|---|---|---|
| Institutional Discharge | Discharge to long term care or continuing care facility at the time of hospital discharge | Date of surgery to date of hospital discharge, or up to one year after surgery (whichever comes first) |
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Inclusion Criteria:
Exclusion Criteria:
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All individuals 66 years of older on the day of their surgery
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| ID | Title | Description |
|---|---|---|
| FG000 | Elective | Individuals having major noncardiac surgery following an elective hospital admission Frailty index: A frailty index composed of variables from health administrative data that cover multi-system health issues. Deficits will be coded as present or absent, and the number of deficits present will be divided by the total number of deficits present to provide an overall score between 0-1. |
| FG001 | Emergency | Individuals having general surgery following an urgent hospital admission Frailty index: A frailty index composed of variables from health administrative data that cover multi-system health issues. Deficits will be coded as present or absent, and the number of deficits present will be divided by the total number of deficits present to provide an overall score between 0-1. |
| Title | Milestones | Reasons Not Completed | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Overall Study |
|
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| ID | Title | Description |
|---|---|---|
| BG000 | Elective Surgery | Individuals having major noncardiac surgery following an elective hospital admission Frailty index: A frailty index composed of variables from health administrative data that cover multi-system health issues. Deficits will be coded as present or absent, and the number of deficits present will be divided by the total number of deficits present to provide an overall score between 0-1. |
| Units | Counts |
|---|---|
| Participants |
|
| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes |
|---|---|---|---|---|---|---|---|---|---|
| Age, Continuous | Analysis for elective and emergency surgery groups were further separated into frail and not frail participants |
| 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 | Survival for One Year After Surgery | Still being alive (no death date) in the registered persons database Outcome is binary, exposure is per 0.1 unit increase | We measured the unadjusted and adjusted associations between the pFI and postoperative outcomes in our elective surgery cohort. The unadjusted analysis contained only the pFI. Data was not collected from Emergency Surgery patients. | Posted | Count of Participants | Participants | Date of surgery to 365 days after surgery |
|
1 year
All-Cause Mortality was monitored
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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 | Elective Noncardiac Surgery | Individuals having major noncardiac surgery following an elective hospital admission Frailty index: A frailty index composed of variables from health administrative data that cover multi-system health issues. Deficits will be coded as present or absent, and the number of deficits present will be divided by the total number of deficits present to provide an overall score between 0-1. |
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Some variables underlying the pFI, such as pharmacy and home-support care data, may not be available in all data systems. Additionally, while the ACG system is the most widely used population-risk software in the world, it is not universally available, and diagnostic codes underlying its clusters are not openly disseminated. Our results represent associations, not causal relationships.
| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Dr. Daniel McIsaac | The Ottawa Hospital | 613-761-4940 | dmcisaac@toh.ca |
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| BG001 | Emergency Surgery | Individuals having general surgery following an urgent hospital admission Frailty index: A frailty index composed of variables from health administrative data that cover multi-system health issues. Deficits will be coded as present or absent, and the number of deficits present will be divided by the total number of deficits present to provide an overall score between 0-1. |
| BG002 | Total | Total of all reporting groups |
| Mean |
| Standard Deviation |
| years |
|
| Sex: Female, Male | Analysis for elective and emergency surgery groups were further separated into frail and not frail participants | Count of Participants | Participants |
|
| OG001 | Emergency Surgery | Individuals having general surgery following an urgent hospital admission Frailty index: A frailty index composed of variables from health administrative data that cover multi-system health issues. Deficits will be coded as present or absent, and the number of deficits present will be divided by the total number of deficits present to provide an overall score between 0-1. |
|
|
| Secondary | Institutional Discharge | Discharge to long term care or continuing care facility at the time of hospital discharge | We measured the unadjusted and adjusted associations between the pFI and postoperative outcomes in our elective surgery cohort. The unadjusted analysis contained only the pFI. Data not collected from Emergency Surgery patients. | Posted | Count of Participants | Participants | Date of surgery to date of hospital discharge, or up to one year after surgery (whichever comes first) |
|
|
|
| 19,540 |
| 415,704 |
| 0 |
| 0 |
| 0 |
| 0 |
| EG001 | Emergency General Surgery | Individuals having general surgery following an urgent hospital admission Frailty index: A frailty index composed of variables from health administrative data that cover multi-system health issues. Deficits will be coded as present or absent, and the number of deficits present will be divided by the total number of deficits present to provide an overall score between 0-1. | 0 | 0 | 0 | 0 | 0 | 0 |
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| Male |
|