Relationship between preoperative patient-reported outcomes and hospital length of stay: a prospective cohort study of general surgery patients in Vancouver, Canada

Sutherland, Jason M.; Liu, Guiping; Crump, Trafford; Karimuddin, Ahmer

doi:10.1177/1355819618791634

Cited by 19 publications

(24 citation statements)

References 30 publications

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“…Our initial hypothesis was that increased levels of perceived pain would correlate with worse patient outcomes such as increased hospital length of stay. This would be in line with the current literature that suggest optimal pain control leads to increased mobility, earlier ambulation and improved outcomes 5–7. Contrary to the literature, we found that higher levels of pain were associated with reduced mortality and reduced LOS.…”

Section: Introductionsupporting

confidence: 91%

“…The MIMIC-III database included 1917 patients who underwent CABG with 844 meeting the study criteria. CABG was chosen for the investigation as it is a common procedure with the majority of patients having no or few postoperative complications and relatively predictable recoveries 5. Due to the nature of the surgical procedure which requires sternal spreading for exposure, there is an expected high analgesic burden immediately after surgery.…”

Section: Casementioning

confidence: 99%

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Counterintuitive results from observational data: a case study and discussion

et al. 2019

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ObjectiveTo explore the issue of counterintuitive data via analysis of a representative case in which the data obtained was unexpected and inconsistent with current knowledge. We then discuss the issue of counterintuitive data while developing a framework for approaching such findings.DesignThe case study is a retrospective analysis of a cohort of coronary artery bypass graft (CABG) patients. Regression was used to examine the association between perceived pain in the intensive care unit (ICU) and selected outcomes.SettingMedical Information Mart for Intensive Care-III, a publicly available, de-identified critical care patient database.Participants844 adult patients from the database who underwent CABG surgery and were extubated within 24 hours after ICU admission.Outcomes30 day mortality, 1 year mortality and hospital length of stay (LOS).ResultsIncreased pain levels were found to be significantly associated with reduced mortality at 30 days and 1 year, and shorter hospital LOS. A one-point increase in mean pain level was found to be associated with a reduction in the odds of 30 day and 1 year mortality by a factor of 0.457 (95% CI 0.304 to 0.687, p<0.01) and 0.710 (95% CI 0.571 to 0.881, p<0.01) respectively, and a 0.916 (95% CI −1.159 to –0.673, p<0.01) day decrease in hospital LOS.ConclusionThe finding of an association between increased pain and improved outcomes was unexpected and clinically counterintuitive. In an increasingly digitised age of medical big data, such results are likely to become more common. The reliability of such counterintuitive results must be carefully examined. We suggest several issues to consider in this analytic process. If the data is determined to be valid, consideration must then be made towards alternative explanations for the counterintuitive results observed. Such results may in fact indicate that current clinical knowledge is incomplete or not have been firmly based on empirical evidence and function to inspire further research into the factors involved.

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Section: Introductionsupporting

confidence: 91%

Section: Casementioning

confidence: 99%

Counterintuitive results from observational data: a case study and discussion

et al. 2019

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“…8 In Ontario, ALC numbers have steadily climbed over the past two decades despite attempts to address the issue. 9 ALC is also costly to the health system, estimated at 2.5 million CAD each day in Ontario 10 and 820 million pounds per year in the United Kingdom. 11 In Canada, the Canada Health Act 12 facilitates the provision of medically necessary hospital and physician care to all insured citizens based on need and not ability to pay.…”

Section: Backg Rou N Dmentioning

confidence: 99%

An alternate level of care plan: Co‐designing components of an intervention with patients, caregivers and providers to address delayed hospital discharge challenges

Kuluski

Cadel

et al. 2020

Health Expectations

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Objective To engage with patients, caregivers and care providers to co‐design components of an intervention that aims to improve delayed hospital discharge experiences. Design This is a qualitative study, which entailed working groups and co‐design sessions utilizing World Café and deliberative dialogue techniques to continually refine the intervention. Setting and Participants Our team engaged with 61 participants (patients, caregivers and care providers) in urban and rural communities across Ontario, Canada. A 7‐member Patient and Caregiver Advisory Council participated in all stages of the research. Results Key challenges experienced during a delayed discharge by patients, caregivers and care providers were poor communication and a lack of care services. Participants recommended a communication guide to support on‐going conversation between care providers, patients and caregivers. The guide included key topics to cover and questions to ask during initial and on‐going conversations to manage expectations and better understand the priorities and goals of patients and caregivers. Service recommendations included getting out of bed and dressed each day, addressing the psycho‐social needs of patients through tailored activities and having a storyboard at the bedside to facilitate on‐going engagement. Discussion and Conclusions Our findings outline ways to meaningfully engage patients and caregivers during a delayed hospital discharge. Combining this with a minimal basket of services can potentially facilitate a better care experience and outcomes for patients, their care providers and families.

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“…Can J Surg/J can chir 2020;63 (5) evidence-based tools for prospectively prioritizing people who are waiting for surgery. However, since 2012 the Vancouver Coastal Health Authority, Providence Health Care and the University of British Columbia have partnered to survey patients awaiting elective surgery about their mental health and wellness.…”

Section: Commentary • Commentaire Commentaire E394mentioning

confidence: 99%

Addressing the mental health of Canadians waiting for elective surgery: a potential positive post-pandemic legacy

Wiseman

Crump

Cadesky

et al. 2020

cjs

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Addressing the mental health of Canadians waiting for elective surgery: a potential positive post-pandemic legacy T he coronavirus disease 2019 (COVID-19) pandemic has strained many aspects of Canadian health care, especially access to elective surgery. With wait times already relatively long, surgeries for more than 100 000 Canadians have been either delayed or cancelled because of the pandemic. While the physical effects of these treatment delays are readily recognized and treated, the impact of waiting for surgery on the mental health of patients usually receives little attention. About 20% of Canadians experience mental illness in any given year, and rates of anxiety, depression and substance abuse have increased since the start of the pandemic. Unfortunately, the further lengthening of waits for elective surgery may induce or exacerbate mental health burdens associated with COVID-19. 1-3 In Canada, the government of British Columbia is thus far alone in providing a general timeline in their prediction of the 17-24 months needed to add new capacity, catch up with the approximately 24 000 elective surgeries that were either cancelled or delayed, and restore prepandemic surgical case volumes. 4 Mental health affects surgical outcomes and length of hospital stay. 5 There is excellent evidence for physically optimizing patients before surgery through smoking cessation, physical activity and nutrition. Likewise, we also need to recognize the contribution of mental health and provide resources for patients' whose symptoms and ability to self-care have been affected by the pandemic. Equity is also a critically important issue, as people with mental illness are less likely to access surgery and their survival can even be affected. Indeed, the provinces of British Columbia, Alberta and Ontario recently released roadmaps for restarting elective operations, and they prioritize surgical access based on diagnosis. This means that surgeons must perform a manual override to reflect patients' symptom severity or pain. Better supports are needed to allow surgical teams to properly assess not only patients' physical health, but also their mental health, and provide them with timely access to care based on need. As Canadian hospitals are "ramping up" their elective operations, governments, hospital administrators, surgeons and referring doctors have limited

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Relationship between preoperative patient-reported outcomes and hospital length of stay: a prospective cohort study of general surgery patients in Vancouver, Canada

Cited by 19 publications

References 30 publications

Counterintuitive results from observational data: a case study and discussion

Counterintuitive results from observational data: a case study and discussion

An alternate level of care plan: Co‐designing components of an intervention with patients, caregivers and providers to address delayed hospital discharge challenges

Addressing the mental health of Canadians waiting for elective surgery: a potential positive post-pandemic legacy

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