[version 1; peer review: 1 approved with reservations]
No competing interests were disclosed.
Various studies across different settings have validated Days Alive and Out of Hospital (DAOH) as a valuable outcome for clinical research in surgery and other fields. However, there is no clear consensus on the definitions and methods used to handle and report DAOH in perioperative care studies.
We aim to identify, describe, and summarize the available research on DAOH to understand how it is being conceptualized and utilized in clinical studies on perioperative care.
We will conduct a scoping review to analyze and synthesize the existing studies using DAOH to measure clinical results on perioperative care. We will search MEDLINE, Embase, Web of Science,
We expect to provide a comprehensive overview of how DAOH is conceptualized and utilized in clinical studies on perioperative care, with particular attention to methodological approaches and the role of electronic health-care records (EHRs) among the different regions.
Globally, over 310 million people undergo surgical procedures each year,
Over 320 million surgeries were needed to address the estimated global burden of disease 2010, for a total of 6.9 billion people worldwide.
As in other low- and middle-income countries, resource-constrained LAC health systems must address the double burden of surgical diseases and postoperative complications
Considering that nearly half of postoperative complications are preventable, enhancing the quality of perioperative care constitutes an opportunity to reduce the risks associated with surgery.
Healthcare systems should establish registries and medical records to facilitate audits and research, and thereby promoting quality assurance of perioperative care and supporting evidence-based decision-making.
Several indicators have been proposed for global surveillance of surgical and anesthesia care to accelerate the development of comprehensive and useful registries, however, a lack of consensus persists.
In a joint collaboration with COMET, the Standardized Endpoints in Perioperative Medicine (StEP) initiative proposed Days Alive and Out of Hospital (DAOH) as the preferred life-impact outcome for surgical and anesthesia clinical studies.
Various studies across different settings have validated DAOH as a valuable outcome for clinical research in surgery and other fields.
Our aim is to identify, describe, and summarize the available research on DAOH to understand how it is being conceptualized and utilized in clinical studies on perioperative care.
We present a protocol of a scoping review, which adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols (PRISMA-P)
We will search and retrieve studies analyzing adult patients (≥18 years) who have undergone surgical treatment or have received perioperative care.
We will include studies analyzing DAOH, defined as a composite outcome that measures the time a patient spends at home or engaged in daily activities outside of any inpatient care or healthcare institution (such as hospitals, long-term care facilities, emergency departments, home hospitalizations, and rehabilitation centers) after surgery. Additionally, we will also consider any alternative measures (such as, additive inverses or multiplicative inverses, percentages or proportions) that can be directly converted into DAOH.
We will not impose restrictions related to cultural/subcultural factors, language, geographic location, racial or gender-based interests, or settings.
Our scoping review will consider both observational studies (cross-sectional studies, case-control studies, retrospective or prospective cohort studies), quasi-experimental designs (interrupted-time series, before-after studies, etc), and experimental studies (controlled clinical trials, either randomized or nonrandomized) exploring any clinical question on perioperative care, regardless of the date of publication or publication status. Additionally, registered protocols with results will be considered for inclusion.
We will exclude systematic reviews (and other evidence synthesis designs), narrative reviews, case reports, case series, editorials, opinion and debate articles, correspondences, conference proceedings, and qualitative studies.
We will search electronic databases from its inception. Restrictions on language, date, or publication status will not be considered. The databases utilized will be:
Ovid MEDLINE(R) ALL/PubMed(R) Embase Web of Science (WoS; Clarivate)
Cochrane Central Register of Controlled Trials (CENTRAL)
The details of the search strategy for MEDLINE, Embase and WoS are available in
| Line | Databases | ||
|---|---|---|---|
| MEDLINE
|
Embase
|
Web of Science
|
|
| 1 | exp Surgical Procedures, Operative/ | exp surgery/ | surgery (Topic) |
| 2 | (surger* or surgi* or operati* or operated or (per?operat* or peri?operat* or ((per or peri) adj (operatory or operative))) or (preoperat* or pre?operat* or pre operat*) or (intraoperat* or intra?operat* or intra operat*) or (pos?operat* or post?operat* or ((pos or post) adj (operatory or operative)))).tw. | (surger* or surgi* or operati* or operated or (per?operat* or peri?operat* or ((per or peri) adj (operatory or operative))) or (preoperat* or pre?operat* or pre operat*) or (intraoperat* or intra?operat* or intra operat*) or (pos?operat* or post?operat* or ((pos or post) adj (operatory or operative)))).tw. | WC=(Surgery) |
| 3 | (“Days at home” or “Time at home” or “Institution days” or “Time in institution” or “Home time” or “Institution time” or “Days out of Institution” or “Days alive and out of the hospital” or “Days alive spent living at home” or “Days alive and out of hospital” or “Days alive out of the hospital” or “Days alive and at home” or “Days alive out of hospital” or “Days alive at home” or “Days alive outside hospital” or “Days at home alive“ or ”Institution-free days” or “Days alive and outside of hospital” or “Time spent alive and out of the hospital” or “Time spent alive and out of hospital” or “Time spent alive and at home” or “Time spent away from the home” or “Time spent away from home” or “Days Spent at Home” or “Days spent in hospital” or “Time spent at home” or “Time spent in hospital“ or ”Hospital-Free Days” or “DAH” or “DAOH”).tw. | (“Days at home” or “Time at home” or “Institution days” or “Time in institution” or “Home time” or “Institution time” or “Days out of Institution” or “Days alive and out of the hospital” or “Days alive spent living at home” or “Days alive and out of hospital” or “Days alive out of the hospital” or “Days alive and at home” or “Days alive out of hospital” or “Days alive at home” or “Days alive outside hospital” or “Days at home alive“ or ”Institution-free days” or “Days alive and outside of hospital” or “Time spent alive and out of the hospital” or “Time spent alive and out of hospital” or “Time spent alive and at home” or “Time spent away from the home” or “Time spent away from home” or “Days Spent at Home” or “Days spent in hospital” or “Time spent at home” or “Time spent in hospital“ or ”Hospital-Free Days” or “DAH” or “DAOH”).tw. | #2 OR #1 |
| 4 | 1 or 2 | 1 or 2 | ALL=((surger* or surgi* or operati* or operated or (per?operat* or peri?operat* or ((per or peri) adj (operatory or operative))) or (preoperat* or pre?operat* or pre operat*) or (intraoperat* or intra?operat* or intra operat*) or (pos?operat* or post?operat* or ((pos or post) adj (operatory or operative))))) |
| 5 | 3 and 4 | 3 and 4 | ALL=((“Days at home” or “Time at home” or “Institution days” or “Time in institution” or “Home time” or “Institution time” or “Days out of Institution” or “Days alive and out of the hospital” or “Days alive spent living at home” or “Days alive and out of hospital” or “Days alive out of the hospital” or “Days alive and at home” or “Days alive out of hospital” or “Days alive at home” or “Days alive outside hospital” or “Days at home alive“ or ”Institution-free days” or “Days alive and outside of hospital” or “Time spent alive and out of the hospital” or “Time spent alive and out of hospital” or “Time spent alive and at home” or “Time spent away from the home” or “Time spent away from home” or “Days Spent at Home” or “Days spent in hospital” or “Time spent at home” or “Time spent in hospital“ or ”Hospital-Free Days” or “DAH” or “DAOH”)) |
| 6 | - | 5 not medline.cr. | #3 OR #4 |
| 7 | - | - | 5 AND #6 |
Ovid MEDLINE(R) ALL/PubMed(R) <1946 to Present>.
Embase <1974 to Present>.
ISI Web Of Science (Clarivate).
Two independent authors will screen the studies based on titles and abstract, with a third author solving discrepancies. We will obtain the full text of each potentially eligible study. Following this, two reviewers will independently assess the full-text articles, with a third reviewer addressing any disagreements to determine the final inclusion. The selection process will be managed using Covidence and summarized using a PRISMA 2020 flow diagram.
Whenever a study has two or more references with the same results, we will studify them, so our unit of analysis will be the studies and not publications.
Data extraction will be performed by two independent authors, and a third reviewer will solve discrepancies. We will collect:
First author Year of publication Identifier (such as DOI or PMID) Location of the study
Protocol registration number Data source (clinical records, prospectively collected clinical data, or administrative electronic health-care records (EHRs)) Population characteristics (including primary diagnoses or conditions, age, and gender) Intervention/exposure characteristics (including type of surgery or procedure, duration, and concomitant surgery or procedure). Data on DAOH:
Outcome denomination (e.g. DAOH, days at home, etc). Outcome definition Outcome prioritization (i.e. primary or secondary outcome) Unit of measurement and descriptive statistics used Statistical considerations (type of variable, type of distribution, inferential statistical analyses used, adjustments performed, etc) Follow-up period (and whether censoring or truncation were applied) Handling of missing data
We will enter the retrieved information into a data extraction form (based on Covidence), after a pilot test is conducted (on five randomly sampled studies) by two authors, with a third reviewer solving discrepancies.
We will present the results descriptively. We expect to synthesize our findings narratively, accompanied with figures and tables (with descriptive statistics).
We expect to provide a comprehensive overview of how DAOH is conceptualized and utilized in clinical studies on perioperative care, with particular attention to geographical variation and the role of electronic health-care records among the different regions, emphasizing findings from Latin America. Additionally, we will explore how DAOH is being integrated into studies using EHRs, given their increasing role in efficiently capturing clinical outcomes. These insights will contribute to a better understanding of the relevance of DAOH, reveal gaps and inconsistencies in its definitions, methodologies, and applications; and guide future research towards standardizing its use in clinical studies, enhancing perioperative care worldwide.
No ethical approval and written consent were required; this study will not involve human participants. We expect to submit a manuscript in a peer-reviewed journal.
OSF: Use of Days Alive and Out of Hospital (DAOH) in clinical studies on perioperative care.
This project contains the following underlying data:
PRISMA-P checklist
OSF: PRISMA-P Use of the patient-centred outcome days alive and out of hospital in clinical studies on perioperative care: a scoping review protocol.
Data are available under the terms of the
Nicolás Meza is a PhD candidate at the Doctorate Program on Biomedical Research and Public Health, Universitat Autònoma de Barcelona, Barcelona, Spain.
I appreciate your endeavors to perform this scoping review! I would make a few changes to strengthen your study protocol.
Though discussing the cost of care and why it is important to understand perioperative morbidity and mortality is compelling, I'm not totally sold on how this applies to DAOH. I would want you to discuss the projected cost savings, or cost implications, to this particular outcome, or to instead focus more of your background on WHY DAOH is a more valuable metric than traditional morbidity/mortality. Is it because DAOH is a
Although you are focusing on DAOH, other classifications should be considered in your review, like Hospital-Free Days (HFDs), and thus included in your methodology for inclusion.
Is the study design appropriate for the research question?
Yes
Is the rationale for, and objectives of, the study clearly described?
Partly
Are sufficient details of the methods provided to allow replication by others?
Partly
Are the datasets clearly presented in a useable and accessible format?
Not applicable
Reviewer Expertise:
health services research, patient-centered outcomes, bioethics, surgery
I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above.