Soha Abdellatif1, Emily Hladkowicz1, Manoj M Lalu1,2,3, Sylvain Boet1,2,4,5,6,7,8, Sylvain Gagne1, Daniel I McIsaac9,10,11. 1. Departments of Anesthesiology & Pain Medicine, University of Ottawa and The Ottawa Hospital, B311-1053 Carling Ave, Ottawa, ON, K1Y 4E9, Canada. 2. Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada. 3. Regenerative Medicine Program, Ottawa Hospital Research Institute, Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, ON, Canada. 4. Institut de Savoir, Hôpital Montfort, Ottawa, ON, Canada. 5. Department of Innovation in Medical Education, University of Ottawa, Ottawa, ON, Canada. 6. Francophone Affairs, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada. 7. Faculty of Education, University of Ottawa, Ottawa, ON, Canada. 8. School of Epidemiology & Public Health, University of Ottawa, Ottawa, ON, Canada. 9. Departments of Anesthesiology & Pain Medicine, University of Ottawa and The Ottawa Hospital, B311-1053 Carling Ave, Ottawa, ON, K1Y 4E9, Canada. dmcisaac@toh.ca. 10. Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada. dmcisaac@toh.ca. 11. School of Epidemiology & Public Health, University of Ottawa, Ottawa, ON, Canada. dmcisaac@toh.ca.
Abstract
PURPOSE: Understanding which outcomes matter most and improving outcomes for the growing population of older surgical patients are top priorities for Canadian anesthesia research. Nevertheless, there is little understanding of which outcomes older surgical patients prioritize most highly. We evaluated how older people prioritized six outcomes after elective noncardiac surgery. These outcomes were recommended in core outcome sets for perioperative medicine. METHODS: Following ethical approval, we conducted a prospective, nested, cross-sectional study of people one year after they had major elective noncardiac surgery. Participants were asked to rate the importance of six commonly measured outcomes (complications, length of stay, discharge disposition, days at home, disability score, and developing a new disability) on an 11-point Likert scale. Open-ended questions elicited other preferences. Pairwise comparisons were evaluated using Bayesian multivariate regression. K-means clustering identified subgroups of patients based on overall prioritization. Thematic analysis was applied to open-ended responses. RESULTS: One hundred and one consecutive participants responded. All outcomes scored at least 7.7/10 on average. Complications and discharge location were most highly rated, but only days at home and length of stay had substantial probability (> 99%) of being rated lower than the other four outcomes. Thematic analysis identified the need for greater procedure-specific information, support services, and physical recovery measures. CONCLUSIONS: Commonly recorded and recommended outcomes are reassuringly relevant to older people; however, system-related measures are less highly valued than those more directly related to health and function. Outcomes may need to be personalized to properly evaluate the success of perioperative care.
PURPOSE: Understanding which outcomes matter most and improving outcomes for the growing population of older surgical patients are top priorities for Canadian anesthesia research. Nevertheless, there is little understanding of which outcomes older surgical patients prioritize most highly. We evaluated how older people prioritized six outcomes after elective noncardiac surgery. These outcomes were recommended in core outcome sets for perioperative medicine. METHODS: Following ethical approval, we conducted a prospective, nested, cross-sectional study of people one year after they had major elective noncardiac surgery. Participants were asked to rate the importance of six commonly measured outcomes (complications, length of stay, discharge disposition, days at home, disability score, and developing a new disability) on an 11-point Likert scale. Open-ended questions elicited other preferences. Pairwise comparisons were evaluated using Bayesian multivariate regression. K-means clustering identified subgroups of patients based on overall prioritization. Thematic analysis was applied to open-ended responses. RESULTS: One hundred and one consecutive participants responded. All outcomes scored at least 7.7/10 on average. Complications and discharge location were most highly rated, but only days at home and length of stay had substantial probability (> 99%) of being rated lower than the other four outcomes. Thematic analysis identified the need for greater procedure-specific information, support services, and physical recovery measures. CONCLUSIONS: Commonly recorded and recommended outcomes are reassuringly relevant to older people; however, system-related measures are less highly valued than those more directly related to health and function. Outcomes may need to be personalized to properly evaluate the success of perioperative care.
Authors: Jason B Liu; Sharon M Weber; Julia R Berian; Shenglin Chen; Mark E Cohen; Clifford Y Ko; Karl Y Bilimoria Journal: JAMA Surg Date: 2016-11-01 Impact factor: 14.766
Authors: Daniel I McIsaac; Monica Taljaard; Gregory L Bryson; Paul E Beaulé; Sylvain Gagne; Gavin Hamilton; Emily Hladkowicz; Allen Huang; John Joanisse; Luke T Lavallée; David MacDonald; Husein Moloo; Kednapa Thavorn; Carl van Walraven; Homer Yang; Alan J Forster Journal: Br J Anaesth Date: 2020-08-07 Impact factor: 9.166
Authors: Daniel I McIsaac; Monica Taljaard; Gregory L Bryson; Paul E Beaule; Sylvain Gagne; Gavin Hamilton; Emily Hladkowicz; Allen Huang; John Joanisse; Luke T Lavallée; Hussein Moloo; Kednapa Thavorn; Carl van Walraven; Homer Yang; Alan J Forster Journal: BMC Anesthesiol Date: 2016-11-14 Impact factor: 2.217
Authors: Oliver Boney; Madeline Bell; Natalie Bell; Ann Conquest; Marion Cumbers; Sharon Drake; Mike Galsworthy; Jacqui Gath; Michael P W Grocott; Emma Harris; Simon Howell; Anthony Ingold; Michael H Nathanson; Thomas Pinkney; Leanne Metcalf Journal: BMJ Open Date: 2015-12-16 Impact factor: 2.692
Authors: Cecilia A C Prinsen; Sunita Vohra; Michael R Rose; Maarten Boers; Peter Tugwell; Mike Clarke; Paula R Williamson; Caroline B Terwee Journal: Trials Date: 2016-09-13 Impact factor: 2.279
Authors: Asangaedem Akpan; Charlotte Roberts; Karen Bandeen-Roche; Barbara Batty; Claudia Bausewein; Diane Bell; David Bramley; Julie Bynum; Ian D Cameron; Liang-Kung Chen; Anne Ekdahl; Arnold Fertig; Tom Gentry; Marleen Harkes; Donna Haslehurst; Jonathon Hope; Diana Rodriguez Hurtado; Helen Lyndon; Joanne Lynn; Mike Martin; Ruthe Isden; Francesco Mattace Raso; Sheila Shaibu; Jenny Shand; Cathie Sherrington; Samir Sinha; Gill Turner; Nienke De Vries; George Jia-Chyi Yi; John Young; Jay Banerjee Journal: BMC Geriatr Date: 2018-02-02 Impact factor: 3.921
Authors: S Ramani Moonesinghe; Danny J N Wong; Laura Farmer; Richard Shawyer; Paul S Myles; Steve K Harris Journal: BMJ Open Date: 2017-09-07 Impact factor: 2.692
Authors: Daniel I McIsaac; Monica Taljaard; Gregory L Bryson; Paul E Beaulé; Sylvain Gagné; Gavin Hamilton; Emily Hladkowicz; Allen Huang; John A Joanisse; Luke T Lavallée; David MacDonald; Husein Moloo; Kednapa Thavorn; Carl van Walraven; Homer Yang; Alan J Forster Journal: Ann Surg Date: 2020-02 Impact factor: 12.969
Authors: Duminda N Wijeysundera; Shabbir M H Alibhai; Karim S Ladha; Martine T E Puts; Tyler R Chesney; Julian F Daza; Sahar Ehtesham; Emily Hladkowicz; Gerald Lebovic; C David Mazer; Janet M van Vlymen; Alice C Wei; Daniel I McIsaac Journal: BMJ Open Date: 2022-06-22 Impact factor: 3.006
Authors: Daniel I McIsaac; Dean A Fergusson; Rachel Khadaroo; Amanda Meliambro; John Muscedere; Chelsia Gillis; Emily Hladkowicz; Monica Taljaard Journal: BMJ Open Date: 2022-08-08 Impact factor: 3.006