Surgery for musculoskeletal conditions is among the fastest growing groups of surgical procedures across the world. Patients undergoing these surgical procedures are at high risk of perioperative and postoperative cardiovascular complications. At present, however, we lack robust data on cardiovascular outcomes for the most frequent performed musculoskeletal surgical procedures. Objectives: The aims of the project are to describe and analyze adverse events associated with musculoskeletal surgical procedures, with particular focus on cardiovascular outcomes and cause-specific mortality. We also aim to evaluate the health care outcomes associate with and following such surgeries, regarding hospital length of stay, costs, re-admission, transfer to nursing homes, and referral to specialized care. Methods: In order to address the aims above, we propose a data linkage study, linking questionnaire data from the 45 and Up Study to follow-up data on hospitalization from the Admitted Patients' Data Collection and to deaths from the NSW Register of Births Deaths and Marriages at The George Institute for Global Health (Australia), and from an adapted questionnaire data, based on the 45 and Up Study, and from the electronic medical records at the Clinics Hospital of Botucatu Medical School (Brazil) of patients admitted to hospital for the surgical procedures performed for hip fracture, and for elective hip, knee, and spinal surgery. Measures of health care use associated with the principal surgical procedure will include length of stay, cost of care, readmission to hospital, use of specialized services such as inpatient rehabilitation and referral to outpatient rehabilitation and admission to nursing homes. Cardiovascular complications will include cardiopulmonary resuscitation, diagnosis codes for cardiorespiratory arrest, acute myocardial infarction, heart failure, respiratory failure, thromboembolic complications, and stroke. Cardiovascular disease development (CVD) up to 2 years post-procedure will also be analyzed as long-term CVD risk. Statistical methods: Linked data will be analyzed predominantly using Cox proportional hazards modelling of individual outcomes relating to cardiovascular complications. Comparisons among procedures will be performed using t tests. Likelihood of reoperation will be also analyses as the percentage of patients with repeat surgery per year of follow-up. Univariate and multivariate Cox regression modelling will be used to quantify the risk of surgical complications and health care.
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