Association of Loss of Independence With Readmission and Death After Discharge in Older Patients After Surgical Procedures

Abstract

Loss of independence, a patient-centered outcome, was associated with postoperative readmissions and death after discharge. Loss of independence can feasibly be collected across multiple hospitals in a national registry. Clinical initiatives to minimize LOI will be important for improving surgical care for older adults.

Patient-Reported Outcomes Measurement Information System (PROMIS) Use in Surgical Care: A Scoping Study

“…In Surgeons have used HRQOL for research on parathyroidectomy (1999) 10 , colectomy (2002) 11 , laparoscopic hernia repair (2006) 12 , open inguinal hernia repair (2010) 13 Quality Improvement Program (ACSNSQIP) hospitals using the SF-36 instrument and found loss of independence associated with postoperative readmissions and death after discharge 15 . 20 .…”

Focus on Surgical Outcomes That Matter to Older Patients

“…Using new geriatric-specific variables from the American College of Surgeons National Quality Improvement Program Geriatric Surgery Pilot Project, the authors found that loss of independence occurred in 59.6% of surgical patients older than 65 years; 26.6% of patients demonstrated a decline in functional status, 32.0% demonstrated a decline in mobility, and 46.0% required increased care. 2 In regression analysis, loss of independence was associated with readmission (odds ratio, 1.7; 95% CI, 1.4-2.2) and death after discharge (odds ratio, 6.7; 95% CI, 2.4-19.3).…”

“…In this issue of JAMA Surgery , Berian et al 2 examine the association between loss of independence (defined as a decline in functional status, deterioration in mobility, or new requirements for special services, such as new home care or skilled nursing facility needs) and 2 postoperative outcomes, readmission and death after discharge. Using new geriatric-specific variables from the American College of Surgeons National Quality Improvement Program Geriatric Surgery Pilot Project, the authors found that loss of independence occurred in 59.6% of surgical patients older than 65 years; 26.6% of patients demonstrated a decline in functional status, 32.0% demonstrated a decline in mobility, and 46.0% required increased care.…”

“…As the authors acknowledge, functional recovery continues past 30 days, and the loss of independence observed in this cohort is unlikely to be permanent. 2 However, even if transient, loss of independence is a substan­tial burden on patients and caregivers. In addition, while activities of daily living, mobility, and care needs are all important determinants of independence, other factors, such as social support, socioeconomic status, the environment, and the patient’s own desires and preferences, also likely influence an individual’s ability to maintain independence, and these factors warrant further investigation.…”

“…As one of the first studies to use variables introduced by the American College of Surgeons Geriatric Surgery Pilot Project, the findings by Berian et al 2 represent an important shift in focus about outcomes after surgical procedures among older individuals. Through analyses like these, we can begin to understand surgical outcomes that are highly valued by our older patients and translate these findings to the bedside.…”