Older Adult Safety in Surgery (OASIS)

老年人手术安全 (OASIS)

• 批准号: 8184416
• 负责人: Alok Kapoor
• 金额: $ 8.45万
• 依托单位: BOSTON MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-08-01 至 2013-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8184416
• 关键词: Academic Medical Centers; Acute suppurative arthritis due to bacteria; Adoption; Affect; Age; Aging; American; Antibiotics; Award; Benefits and Risks; Boston; Chest; Clinical; Clinical Practice Guideline; Cohort Studies; Comorbidity; Companions; Computer Simulation; Computers; Costs and Benefits; Data; Data Sources; Deep Vein Thrombosis; Diagnostic; Disease; Elderly; Equilibrium; Event; Faculty; Future; Goals; Guidelines; Healthcare; Hemorrhage; Hospital Societies; Hospitalists; Hospitals; Incidence; Individual; Injury; Intervention; Intravenous; Irrigation; Joint by Site; Knowledge; Lead; Low-Molecular-Weight Heparin; Measures; Medical; Medicare; Medicine; Methods; Modeling; Morbidity - disease rate; Natural History; Operative Surgical Procedures; Outcome; Patients; Perioperative; Pharmaceutical Preparations; Physicians; Policies; Policy Maker; Population; Postoperative Period; Postphlebitic Syndrome; Prevalence; Prevention strategy; Procedures; Prophylactic treatment; Provider; Public Health; Publishing; Pulmonary Embolism; Pulmonary Hypertension; Quality of life; Randomized Controlled Trials; Regimen; Regression Analysis; Relative (related person); Relative Risks; Replacement Arthroplasty; Research; Research Personnel; Risk; Safety; Sample Size; Source; Techniques; Therapeutic; Thromboembolism; Total Hip Replacement; Translating; United States; Venous; Veterans; cohort; college; cost; disability; follow-up; fondaparinux; health economics; health related quality of life; high risk; improved; injury prevention; innovation; insight; joint stiffness; knee replacement arthroplasty; member; models and simulation; mortality; prevent; simulation; statistics

DESCRIPTION (provided by applicant): I am a faculty member in the Hospital Medicine Unit at Boston University Medical Center who seeks the GEMSSTAR R03 Award under the auspices of the Society of Hospital Medicine which is sponsoring a companion T. Franklin Williams award. These awards will enable me to transition into an independent hospitalist investigator in aging research. The proposal, entitled "Older Adult Safety in Surgery (OASIS)" focuses on identifying optimal perioperative injury prevention strategies in older adults with a single and co-occurring comorbidities undergoing surgery by measuring their associated long term health related quality of life, survival, and costs using a computer disease simulation model. Medical injury is common after major surgery and disproportionately affects older adults with comorbidities. The proposal uses venous thromboembolism (VTE) prophylaxis after total hip and knee replacement as a first case example of a method which may be replicated for numerous other safety targets. The American College of Chest Physicians recommends exclusively high potency prophylaxis in this setting. High potency agents including fondaparinux and LMWH are highly effective in reducing the incidence of VTE but concerns about increased rates of bleeding with these regimens have slowed their widespread adoption especially in older adults. Selecting the optimal intervention to prevent medical injury usually involves balancing its risks, benefits, and costs. These have not been carefully studied for most procedures, particularly for older adults with comorbidities and co-occurring comorbidities. In this proposal, I will use computer disease simulation to integrate data from published randomized controlled trials about the efficacy of high potency prophylaxis, cohort data about the background risk of VTE, and cost from Medicare reimbursement statistics to project long term outcomes related to various prophylaxis strategies. Then, I will measure the relative risk of VTE and bleeding in subpopulations of older adults with prevalent comorbidities using regression analyses of Veterans Affairs data and project long term outcomes with the simulation model in these subpopulations. If the conclusions about the value of high potency prophylaxis changes in the subpopulations, the method outlined would represent a major innovation in the perioperative assessment of older adult surgical patient. PUBLIC HEALTH RELEVANCE: Choosing the appropriate VTE prophylaxis regimen given associated risks for older adults undergoing total joint replacement is one example of the difficult risk-benefit decisions that must be made by physicians and patients in the perioperative period. Understanding the relationship between comorbidities and risk of injury will be instrumental to determining the optimal prevention strategies for physicians, patients, and policy makers.

描述（由申请人提供）：我是波士顿大学医学中心医院医学部门的一名教员，在医院医学协会的赞助下寻求GEMSSTAR R03奖，该协会还赞助了T.富兰克林·威廉姆斯奖。这些奖项将使我过渡到一个独立的医院研究者在老龄化研究。这项名为“手术中的老年人安全（OASIS）”的提案侧重于通过使用计算机疾病模拟模型测量其相关的长期健康相关生活质量、生存率和成本，确定具有单一和并发合并症的老年人手术围手术期损伤预防的最佳策略。医疗损伤是常见的大手术后，不成比例地影响老年人的合并症。该建议使用全髋关节和膝关节置换术后静脉血栓栓塞（VTE）预防作为该方法的第一个案例，该方法可以复制用于许多其他安全目标。美国胸科医师学会建议在这种情况下进行高效预防。包括fondaparinux和低分子肝素在内的高效药物在降低静脉血栓栓塞发生率方面非常有效，但对这些方案增加出血率的担忧延缓了它们的广泛采用，特别是在老年人中。选择最佳的干预措施，以防止医疗伤害通常涉及平衡其风险，收益和成本。对于大多数手术，特别是对于有合并症和并发合并症的老年人，这些还没有得到仔细的研究。在本提案中，我将使用计算机疾病模拟来整合已发表的关于高效预防疗效的随机对照试验数据，关于静脉血栓栓塞背景风险的队列数据，以及来自医疗保险报销统计的成本，以预测与各种预防策略相关的长期结果。然后，我将使用退伍军人事务数据的回归分析来测量具有普遍合并症的老年人亚群中静脉血栓栓塞和出血的相对风险，并在这些亚群中使用模拟模型来预测长期结果。如果关于高效预防在亚人群中的价值的结论发生变化，那么概述的方法将代表老年外科患者围手术期评估的重大创新。