Background

Days alive and out of hospital (DAOH) is a composite, patient-centred outcome measure describing a patient's postoperative recovery, encompassing hospitalisation and mortality. DAOH is the number of days not in hospital over a defined postoperative period; patients who die have DAOH of zero. The Standardising Endpoints in Perioperative Medicine (StEP) group recommended DAOH as a perioperative outcome. However, DAOH has never been validated in patients undergoing emergency laparotomy. Here, we validate DAOH after emergency laparotomy and establish the optimal duration of observation.

Methods

Prospectively collected data of patients having emergency laparotomy in England (December 1, 2013–November 30, 2017) were linked to national hospital admission and mortality records for the year after surgery. We evaluated construct validity by assessing DAOH variation with known perioperative risk factors and predictive validity for 1 yr mortality using a multivariate Bayesian mixed-effects logistic regression. The optimal postoperative DAOH period (30 or 90 days) was judged on distributional and pragmatic properties.

Results

We analysed 78 921 records. The median 30-day DAOH (DAOH₃₀) was 16 (inter-quartile range [IQR], 0–22) days and the median DAOH₉₀ was 75 (46–82) days. DAOH was shorter in the presence of known perioperative risk factors. For patients surviving the first 30 postoperative days, shorter DAOH₃₀ was associated with higher 1-yr mortality (odds ratio=0.94; 95% credible interval, 0.94–0.94).

Conclusion

DAOH is a valid, patient-centred outcome after emergency laparotomy. We recommend its use in clinical trials, quality assurance, and quality improvement, measured at 30 days as mortality heavily skews DAOH measured at 90 days and beyond.

中文翻译：

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紧急剖腹手术后存活天数和出院结果测量的验证：一项回顾性队列研究

背景

住院天数和出院天数 (DAOH) 是一种以患者为中心的复合结果测量方法，描述了患者的术后恢复情况，包括住院和死亡率。DAOH 是在规定的术后期间内未住院的天数；死亡患者的 DAOH 为零。围手术期医学标准化终点 (StEP) 组建议将 DAOH 作为围手术期结果。然而，DAOH 从未在接受紧急剖腹手术的患者中得到验证。在这里，我们在紧急剖腹手术后验证 DAOH 并确定最佳观察持续时间。

方法

前瞻性收集的英格兰急诊剖腹手术患者数据（2013 年 12 月 1 日至 2017 年 11 月 30 日）与手术后一年的全国住院和死亡率记录相关联。我们通过使用多元贝叶斯混合效应逻辑回归评估 DAOH 变异与已知的围手术期风险因素和 1 年死亡率的预测有效性来评估结构有效性。最佳术后 DAOH 期（30 或 90 天）根据分布和实用特性进行判断。

结果

我们分析了 78 921 条记录。中位 30 天 DAOH (DAOH ₃₀ ) 为 16 (四分位距 [IQR], 0-22) 天，中位 DAOH ₉₀为 75 (46-82) 天。在存在已知围手术期危险因素的情况下，DAOH 较短。对于术后前 30 天幸存的患者，较短的 DAOH ₃₀与较高的 1 年死亡率相关（优势比 = 0.94；95% 可信区间，0.94-0.94）。

结论

DAOH 是紧急剖腹手术后有效的、以患者为中心的结果。我们建议将其用于临床试验、质量保证和质量改进，以 30 天测量，因为死亡率严重偏离 90 天及以后测量的 DAOH。