Patient-centred outcomes are increasingly recognised as crucial measures of healthcare quality. Days alive and at home up to 30 days after surgery (DAH₃₀) is a validated and readily obtainable patient-centred outcome measure that integrates much of the peri-operative patient journey. However, the minimal difference in DAH₃₀ that is clinically important to patients is unknown. We designed and administered a 28-item survey to evaluate the minimal clinically important difference in DAH₃₀ among adult patients undergoing inpatient surgery. Patients were approached pre-operatively or within 2 days postoperatively. We did not study patients undergoing day surgery or nursing home residents. Patients ranked their opinions on the importance of discharge home using a Likert scale (from 1, not important at all to 6, extremely important) and the minimum number of extra days at home that would be meaningful using this scale. We recruited 104 patients; the survey was administered pre-operatively to 45 patients and postoperatively to 59 patients. The mean (SD) age was 53.5 (16.5) years, and 51 (49%) patients were male. Patients underwent a broad range of surgery of mainly intermediate (55%) to major (33%) severity. The median minimal clinically important difference for DAH₃₀ was 3 days; this was consistent across a broad range of scenarios, including earlier discharge home, complications delaying hospital discharge and the requirement for admission to a rehabilitation unit. Discharge home earlier than anticipated and discharge home rather than to a rehabilitation facility were both rated as important (median score = 5). Empirical data on the minimal clinically important difference for DAH₃₀ may be useful to determine sample size and to guide the non-inferiority margin for future clinical trials.

中文翻译：

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术后 30 天内在家中的天数具有最小的临床意义差异

以患者为中心的结果越来越被认为是衡量医疗质量的关键指标。手术后最多 30 天的存活天数和在家中的天数 (DAH ₃₀ ) 是一种经过验证且易于获得的以患者为中心的结果测量方法，它整合了围手术期患者的大部分旅程。然而，对患者临床重要的 DAH ₃₀的最小差异尚不清楚。我们设计并实施了一项 28 项调查，以评估 DAH _{30的最小临床重要差异}在接受住院手术的成年患者中。患者在术前或术后 2 天内就诊。我们没有研究接受日间手术的患者或疗养院居民。患者使用李克特量表（从 1，完全不重要到 6，非常重要）对他们对出院回家重要性的看法以及使用该量表有意义的在家的最少额外天数进行排名。我们招募了 104 名患者；该调查在术前对 45 名患者进行，对 59 名患者在术后进行。平均 (SD) 年龄为 53.5 (16.5) 岁，51 (49%) 名患者为男性。患者接受了范围广泛的手术，主要为中等（55%）至严重（33%）严重程度。_{DAH 30}的中位最小临床重要差异是3天；这在广泛的情况下是一致的，包括提前出院、并发症延迟出院以及需要进入康复部门。比预期更早出院和出院而不是去康复机构都被评为重要（中位数 = 5）。_{关于 DAH 30}的最小临床重要差异的经验数据可能有助于确定样本量并指导未来临床试验的非劣效性界限。