Patient prioritization of routine and patient-reported postoperative outcome measures: a prospective, nested cross-sectional study

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

A randomised controlled feasibility trial of a clinical protocol to manage hypotension during major non‐cardiac surgery

“…Whether outcomes based on laboratory test results (e.g. myocardial injury, AKI) have direct relevance to patients is unclear, and patients may instead prioritise major postoperative complications as an important outcome [40]. Given the diverse events that comprise major complications, as well as their multifactorial aetiology, the proposed clinical protocol likely has a smaller plausible treatment effect on this more patient‐relevant outcome.…”

Functional Improvement Trajectories After Surgery (FIT After Surgery) study: protocol for a multicentre prospective cohort study to evaluate significant new disability after major surgery in older adults

“…Open access events such as death, major complications and length of hospitalisation. Since these outcomes may miss important domains that are especially relevant to older adults, 7 significant postoperative disability has gained increasing attention as a patient-centred postoperative outcome. 8 Based on the International Classification of Functioning, Disability and Health framework, 9 10 disability is an umbrella term that covers impairments in body function (ie, physiological functions of body systems), limitations in activity (ie, difficulties executing tasks or actions) and participation restrictions (ie, problems with involvement in life situations).…”

“…First, older adults report freedom from disability as being a highly important postoperative outcome. 7 Indeed, they may prioritise preservation of function and cognition over survival when making treatment decisions for life-threatening diseases. 11 Second, disability integrates the overall impact of various adverse events (eg, myocardial infarction, acute stroke, surgical site infection) on patients' recovery after surgery.…”

“…Typical standard approaches to measure postoperative recovery have focused on routinely measured events such as death, major complications and length of hospitalisation. Since these outcomes may miss important domains that are especially relevant to older adults,7 significant postoperative disability has gained increasing attention as a patient-centred postoperative outcome 8…”

“…Freedom from significant new disability has several advantages as a measure of intermediate-to-long term recovery after major surgery. First, older adults report freedom from disability as being a highly important postoperative outcome 7. Indeed, they may prioritise preservation of function and cognition over survival when making treatment decisions for life-threatening diseases 11.…”