Project Details
Projekt
PAtient-Centred Outcomes and Resource Utilisation after noncardiac and non- neurosurgical Surgery-D(EUTSCHLAND) (PACORUS-D)-secondary data cohort
Subject Area
Public Health, Healthcare Research, Social and Occupational Medicine
Term
since 2024
Project identifier
Deutsche Forschungsgemeinschaft (DFG) - Project number 544101681
In Europe, the estimated need for surgical interventions amounts to annually 5,000-5,500 procedures/100,000 or 37-40 million procedures per year. Death within 30 days of a surgical procedure was reported globally as the third most common cause of mortality. While traditionally “surviving the procedure” has been the main benchmark, advances in perioperative safety spotlighted functional outcomes. Accurate outcome assessment is crucial for perioperative medicine: it is the foundation for patient information and as such the precondition for valid patient`s consent to surgery; it allows for safety and quality monitoring; it provides guidance for resource allocation and it is prerequisite for the development, design, and evaluation of interventions. Days Alive and Out of Hospital (DAOH) was proposed in the perioperative setting in 2017 as outcome metric. However, major uncertainties remain regarding DAOH as peri-operative endpoint: a) DAOH has been validated in selected populations; b) it was validated in a limited number of health care systems in spite of data suggesting impact of health care structure and of socioeconomics factors; c) the validity of DAOH as a measure of resource utilization has been postulated but not quantified; d) different approaches to calculation of DAOH have been used. The aim of this methodological project is to validate DAOH and to obtain a patient-centred AND easily collected, statistically efficient integrative endpoint for the evaluation of intervention in perioperative health care delivery (e.g. shared care approaches) or health care structure interventions in perioperative public health. We will conduct a cohort study in non-cardiac, non-neurosurgical surgery patients. Data source is the database maintained by the statutory health insurance AOK Rheinland/Hamburg. The project will pursue the following objectives: 1) to quantify days alive and out of hospital (DAOH) at 30 and 365 days after surgery in an unselected population submitted to non-cardiac and non-neurosurgical surgery; 2) to evaluate the construct (convergent) validity of DAOH in terms of preoperative risk factors/procedural risk and postoperative complications in Germany; 3) to evaluate the concurrent and predictive validity of DAOH as measure of health services resource utilization (in and out-of-hospital) and total costs at 30 and 365 days after surgery; 4) to quantify (potential) effect modification by sex, socioeconomic status and structure of the district of residency on the construct and criterion validity of DAOH; 5) to explore in a sensitivity analysis the construct and criterion validity of DAOH using the alternative DAOH calculation approaches. The sample size will be in the order of >90,000 individuals based on the number of insured individuals fulfilling the eligibility criteria in the database of the statutory health insurer in recent years. This large sample size will be sufficient for the planned correlation and regression analyses.
DFG Programme
Research Grants
Co-Investigators
Dr. Silke Andrich; Dr. Manuela Brüne; Privatdozentin Dr. Carina Jaekel; Dr. Lisa Oezel
