Evidence map›Paper›PMID 40562633›Full record

ArticleBritish journal of anaesthesia2025

Description and validation of the Postoperative Discharge Recovery State outcome: a patient-partnered population-based cohort study.

Emily Hladkowicz, Gurlavine Kidd, Alana Flexman, Allan Garland, Julie Hallet, Daniel Kobewka, Matthew McGarr, Robert Talarico, Carl van Walraven, Duminda N Wijeysundera and 4 more

Abstract readValidation Study
PubMed Full text at PMC Publisher
In one paragraph

Article in British journal of anaesthesia, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

14 authors.

Emily HladkowiczAcute Care Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
Gurlavine KiddPatient Engagement in Acute Care Research Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
Alana FlexmanDepartment of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, BC, Canada; Department of Anesthesia, St. Paul's Hospital, Providence Health Care, Vancouver, BC, Canada; Centre for Advancing Health Outcomes, St. Paul's Hospital, Vancouver, BC, Canada.
Allan GarlandDepartment of Medicine, University of Manitoba, Winnipeg, MB, Canada.
Julie HalletDepartment of Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
Daniel KobewkaDepartment of Medicine, Bruyère Research Institute, Ottawa, ON, Canada.
Matthew McGarrDepartment of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada.
Robert TalaricoICES uOttawa, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
Carl van WalravenDepartment of Medicine, University of Ottawa, Ottawa, ON, Canada.
Duminda N WijeysunderaDepartment of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada; Department of Anesthesia, St. Michael's Hospital, Toronto, ON, Canada.
Camilla L WongDivision of Geriatric Medicine, St. Michael's Hospital, Toronto, ON, Canada.
Daniel I McIsaacAcute Care Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada; Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada; Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, Ottawa, ON, Canada. Electronic address: dmcisaac@toh.ca.
NOTIFY Investigator Group
Canadian Perioperative Anesthesia Clinical Trials Group

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundOlder adults prioritise independent return home after surgery. Most discharge outcomes are binary composites that do not incorporate temporal information. We defined and validated a novel ordinal outcome, the Postoperative Discharge Recovery State, and prioritised its temporal measurement, to overcome these limitations.

methodsThis retrospective cohort study was conducted with patient partnership. Adults ≥65 yr having major, elective, noncardiac, non-orthopaedic surgery were identified from 2012 to 2022 using linked, routinely collected data in Ontario, Canada. Construct, convergent, and predictive validity were estimated. A multivariable ordinal regression model was derived and internally-externally validated.

resultsWe included 84 422 older adult surgical patients. At the patient-prioritised postoperative day 90, the distribution of patients across Postoperative Discharge Recovery State categories was: (1) dead (2718; 3.2%); (2) hospitalised (1696; 2.0%); (3) in long-term care (179; 0.2%); (4) in rehabilitation (593; 0.7%); and (5) at home (79 236; 93.9%). Directionally expected associations with baseline characteristics supported construct validity. Consistency in associations over time supported reliability. Relationships with days alive and at home supported convergent (ρ=0.373) and predictive (fewer days at home with worse recovery state) validity. A prespecified ordinal logistic regression model had inadequate accuracy (c-statistic 0.700, poor calibration) to support its clinical use.

conclusionsThe Postoperative Discharge Recovery State is a 5-level ordinal outcome that can be applied at key time points after surgery to quantify the proportion of patients in patient-prioritised discharge locations. Validity and reliability support utility, but further development will be required to maximise information gain relative to binary outcomes.

Indexed as

Patient DischargeAgedAged, 80 and overCohort StudiesFemaleHumansMaleOntarioPostoperative PeriodRecovery of FunctionReproducibility of ResultsRetrospective Studiesepidemiologygeriatricspatient-oriented researchsurgeryvalidation

Identifiers

PMID40562633
PMCPMC12489357

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.