PMID- 35012739
OWN - NLM
STAT- MEDLINE
DCOM- 20220307
LR  - 20220307
IS  - 1471-6771 (Electronic)
IS  - 0007-0912 (Linking)
VI  - 128
IP  - 3
DP  - 2022 Mar
TI  - Validation of the days alive and out of hospital outcome measure after emergency 
      laparotomy: a retrospective cohort study.
PG  - 449-456
LID - S0007-0912(21)00794-7 [pii]
LID - 10.1016/j.bja.2021.12.006 [doi]
AB  - BACKGROUND: Days alive and out of hospital (DAOH) is a composite, patient-centred 
      outcome measure describing a patient's postoperative recovery, encompassing 
      hospitalisation and mortality. DAOH is the number of days not in hospital over a 
      defined postoperative period; patients who die have DAOH of zero. The 
      Standardising Endpoints in Perioperative Medicine (StEP) group recommended DAOH 
      as a perioperative outcome. However, DAOH has never been validated in patients 
      undergoing emergency laparotomy. Here, we validate DAOH after emergency 
      laparotomy and establish the optimal duration of observation. METHODS: 
      Prospectively collected data of patients having emergency laparotomy in England 
      (December 1, 2013-November 30, 2017) were linked to national hospital admission 
      and mortality records for the year after surgery. We evaluated construct validity 
      by assessing DAOH variation with known perioperative risk factors and predictive 
      validity for 1 yr mortality using a multivariate Bayesian mixed-effects logistic 
      regression. The optimal postoperative DAOH period (30 or 90 days) was judged on 
      distributional and pragmatic properties. RESULTS: We analysed 78 921 records. The 
      median 30-day DAOH (DAOH(30)) was 16 (inter-quartile range [IQR], 0-22) days and 
      the median DAOH(90) was 75 (46-82) days. DAOH was shorter in the presence of 
      known perioperative risk factors. For patients surviving the first 30 
      postoperative days, shorter DAOH(30) was associated with higher 1-yr mortality 
      (odds ratio=0.94; 95% credible interval, 0.94-0.94). CONCLUSION: DAOH is a valid, 
      patient-centred outcome after emergency laparotomy. We recommend its use in 
      clinical trials, quality assurance, and quality improvement, measured at 30 days 
      as mortality heavily skews DAOH measured at 90 days and beyond.
CI  - Copyright (c) 2021 British Journal of Anaesthesia. Published by Elsevier Ltd. All 
      rights reserved.
FAU - Spurling, Leigh-James
AU  - Spurling LJ
AD  - Surgical Outcomes Research Centre (SOuRCe), Centre for Perioperative Medicine, 
      Division of Surgical and Interventional Science, University College London, 
      London, UK; Department of Anaesthesia and Perioperative Medicine, University 
      College London Hospitals, London, UK. Electronic address: 
      lj.spurling@doctors.org.uk.
FAU - Moonesinghe, S Ramani
AU  - Moonesinghe SR
AD  - Surgical Outcomes Research Centre (SOuRCe), Centre for Perioperative Medicine, 
      Division of Surgical and Interventional Science, University College London, 
      London, UK; Department of Anaesthesia and Perioperative Medicine, University 
      College London Hospitals, London, UK.
FAU - Oliver, C Matthew
AU  - Oliver CM
AD  - Surgical Outcomes Research Centre (SOuRCe), Centre for Perioperative Medicine, 
      Division of Surgical and Interventional Science, University College London, 
      London, UK; Department of Anaesthesia and Perioperative Medicine, University 
      College London Hospitals, London, UK.
LA  - eng
PT  - Journal Article
DEP - 20220107
PL  - England
TA  - Br J Anaesth
JT  - British journal of anaesthesia
JID - 0372541
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Bayes Theorem
MH  - England
MH  - Female
MH  - Hospitalization/*statistics & numerical data
MH  - Hospitals/*supply & distribution
MH  - Humans
MH  - Laparotomy/*statistics & numerical data
MH  - Male
MH  - Middle Aged
MH  - Outcome Assessment, Health Care/*statistics & numerical data
MH  - Patient Readmission/statistics & numerical data
MH  - Retrospective Studies
MH  - Risk Factors
MH  - Time Factors
MH  - Treatment Outcome
MH  - Young Adult
OTO - NOTNLM
OT  - anaesthesia
OT  - days alive and out of hospital
OT  - emergency laparotomy
OT  - morbidity
OT  - perioperative medicine
OT  - perioperative outcomes
OT  - standardised endpoint
OT  - surgery
EDAT- 2022/01/12 06:00
MHDA- 2022/03/08 06:00
CRDT- 2022/01/11 06:01
PHST- 2021/01/27 00:00 [received]
PHST- 2021/07/29 00:00 [revised]
PHST- 2021/12/05 00:00 [accepted]
PHST- 2022/01/12 06:00 [pubmed]
PHST- 2022/03/08 06:00 [medline]
PHST- 2022/01/11 06:01 [entrez]
AID - S0007-0912(21)00794-7 [pii]
AID - 10.1016/j.bja.2021.12.006 [doi]
PST - ppublish
SO  - Br J Anaesth. 2022 Mar;128(3):449-456. doi: 10.1016/j.bja.2021.12.006. Epub 2022 
      Jan 7.