The Impact of Perioperative Geriatric Care on Outcomes After Elective Noncardiac Surgery

Study Overview
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Brief Summary
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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

Detailed Description
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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.

Official Title
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The Impact of Perioperative Geriatric Care on Outcomes After Elective Noncardiac Surgery

Conditions
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SURGICAL PROCEDURES, OPERATIVE, Aged, Epidemiology, Mortality

Intervention / Treatment
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* Procedure: Preoperative geriatric consult or assessment
* Procedure: No Preoperative geriatric consult or assessment


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: >65 Resident of Ontario Having elective non-cardiac surgery (inpatient admission) Exclusion Criteria: Residing in a nursing home or long term care facility at baseline

Ages Eligible for Study
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Minimum Age: 65 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Preoperative geriatric consult or assessment<br>Patients who have a geriatric assessment of consult billed in the 4 months before surgery | Procedure: Preoperative geriatric consult or assessment<br>* 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.<br>|
| No Preoperative geriatric consult or assessment<br>Patients who do not have a geriatric assessment of consult billed in the 4 months before surgery | Procedure: No Preoperative geriatric consult or assessment<br>* No assessment or consult billed in the 4 months before surgery<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| 90-day survival | Death from any cause in the 90 days after surgery | date of surgery to day of death or 365 days after surgery, whichever comes first | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Patient safety event | Any Type 2 diagnostic code for a patient-safety event as described by Southern et al, Medical Care 2016 | surgery to hospital discharge, or up to 365 days after surgery | 
| Hospital length of stay |  | date of surgery to date of hospital discharge, or 365 days after surgery, whichever comes first | 
| 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 to 30 days after discharge | 
| Health Utility Index | A health utility index will be constructed, and used as an outcome if an adequate number of participants have required measures to support multivariable modelling | in the 365 days following surgery |