Validation of days at home as an outcome measure after surgery: a prospective cohort study in Australia

Abstract

ObjectiveTo evaluate ‘days at home up to 30 days after surgery’ (DAH30) as a patient-centred outcome measure.DesignProspective cohort study.Data sourceUsing clinical trial data (seven trials, 2109 patients) we calculated DAH30from length of stay, readmission, discharge destination and death up to 30 days after surgery.Main outcomeThe association between DAH30and serious complications after surgery.ResultsOne or more complications occurred in 263 of 1846 (14.2%) patients, including 19 (1.0%) deaths within 30 days of surgery; 245 (11.6%) patients were discharged to a rehabilitation facility and 150 (7.1%) were readmitted to hospital within 30 days of surgery. The median DAH30was significantly less in older patients (p<0.001), those with poorer physical functioning (p<0.001) and in those undergoing longer operations (p<0.001). Patients with serious complications had less days at home than patients without serious complications (20.5 (95% CI 19.1 to 21.9) vs 23.9 (95% CI 23.8 to 23.9) p<0.001), and had higher rates of readmission (16.0% vs 5.9%; p<0.001). After adjusting for patient age, sex, physical status and duration of surgery, the occurrence of postoperative complications was associated with fewer days at home after surgery (difference 3.0(95% CI 2.1 to 4.0) days; p<0.001).ConclusionsDAH30has construct validity and is a readily obtainable generic patient-centred outcome measure. It is a pragmatic outcome measure for perioperative clinical trials.