Older Adult Safety in Surgery (OASIS)

老年人手术安全 (OASIS)

基本信息

批准号：
8309029
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
项目类别：
财政年份：
2011
资助国家：
美国
起止时间：
2011-08-01 至 2014-07-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8309029
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

项目摘要

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.

描述（由申请人提供）：我是波士顿大学医学中心医院医学部的一名教员，正在医院医学协会的赞助下寻求 GEMSSTAR R03 奖，该协会正在赞助 T. Franklin Williams 奖。这些奖项将使我能够转变为衰老研究领域的独立住院医师调查员。该提案题为“老年人手术安全（OASIS）”，重点是通过测量患有单一和共存合并症的老年人在接受手术时确定最佳的围手术期损伤预防策略，方法是测量老年人与健康相关的生活质量、生存率和生存率。使用计算机疾病模拟模型的成本。大手术后医疗损伤很常见，并且对患有合并症的老年人影响更大。该提案使用全髋关节和膝关节置换术后的静脉血栓栓塞（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专门进行高效预防。包括磺达肝素和 LMWH 在内的高效药物在降低 VTE 发生率方面非常有效，但由于担心这些治疗方案出血率增加，因此放慢了它们的广泛采用，尤其是在老年人中。选择最佳干预措施来预防医疗伤害通常需要平衡其风险、收益和成本。对于大多数手术，特别是对于患有合并症和同时发生的合并症的老年人来说，这些还没有经过仔细研究。在本提案中，我将使用计算机疾病模拟来整合已发表的有关高效预防的功效的随机对照试验的数据、有关 VTE 背景风险的队列数据以及医疗保险报销统计数据的成本，以预测与各种预防相关的长期结果策略。然后，我将使用退伍军人事务部数据的回归分析来测量患有普遍合并症的老年人亚群中 VTE 和出血的相对风险，并使用模拟模型在这些亚群中预测长期结果。如果关于高效预防价值的结论在亚人群中发生变化，那么所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。