An evaluation of the outcome metric ‘days alive and at home’ in older patients after hip fracture surgery

Abstract

Days alive and at home´is a validated measure that estimates the time spent at home, defined as the place of residence before admission to hospital. We evaluated this metric in older adults after hip fracture surgery and assessed two follow-up durations, 30 and 90 days. Patients aged ≥ 70 years who underwent hip fracture surgery were identified retrospectively via hospital admission and government mortality records. Patients who successfully returned home and were still alive within 90 days of surgery were distinguished from those who were not. Regression models were used to examine which variables were associated with failure to return home and number of days at home among those who did return, within 90 days of surgery. We analysed the records of 825 patients. Median (IQR [range]) number of days at home within 90 days (n = 788) was 54 (0-76 [0-88]) days and within 30 days (n = 797) it was 2 (0-21 [0-28]) days. Out of these, 274 (35%) patients did not return home within 90 days and 374 (47%) within 30 days after surgery. Known peri-operative risk-factors such as older age, pre-operative anaemia and postoperative acute renal impairment were associated with failure to return home. This study supports days alive and at home as a useful patient-centred outcome measure in older adults after hip fracture surgery. We recommend that this metric should be used in clinical trials and measured at 90, rather than 30, postoperative days. As nearly half of this patient population did not return home within 30 days, the shorter time-period catches fewer meaningful events.

Associations of sex, Alzheimer's disease and related dementias, and days alive and at home among older Medicare beneficiaries recovering from hip fracture

“…22 Days at home, specifically DAAH, in hip fracture patients has been assessed as a patient-centered outcome available from routine health data with strong face, construct, and predictive validity. [22][23][24] DAAH is a composite measure of days spent alive and not in a hospital, rehabilitation facility, emergency department, or nursing home after the index hospital admission. 22 DAAH is associated with physical function, quality of life, and supports (social and structural) that enable a person to stay at home-suggesting it is a useful and unique outcome to evaluate disparities in post-fracture recovery.…”

“…Work from Australia on days at home in hip fracture patients has revealed that 47% of patients did not return home by 30 days and 35% were not home at 90 days. 22 This work…”

Death is not the worst that can happen: risk scoring and outcomes in emergency laparotomy

“…For some, this may be the ability to return to independent living, for others a return to work, and indeed for some it will just be `staying alive´. There has been a move towards more patient-centred outcomes with measures such as days alive and out of hospital [9]. This may give the patient an idea of the healthcare burden they may have to endure after an operation, but ultimately still isn't what the patient really wishes to know.…”

How to write a retrospective observational study

“…It could also look for differences between groups with different exposures as a formal case control or cohort study. It would be possible to go even further and use an outcome metric that would be important to patients, such as days alive and at home at 90 postoperative days [3].…”