Association of surgery type and duration of hospitalisation with the ability to live independently after surgery

Linhardt, Felix C.; Wachtendorf, Luca J.; Wongtangman, Karuna; Azimaraghi, Omid; Schaefer, Maximilian S.; Eikermann, Matthias; Kendale, Samir

doi:10.1016/j.bja.2021.06.007

Cited by 3 publications

(2 citation statements)

References 11 publications

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“…The primary outcome was a patient's loss of the ability to live independently after surgery, defined as postoperative discharge to a long-term skilled nursing facility or long-term nursing home as previously published and referred to as adverse discharge disposition or nonhome discharge after surgery. 11,12 Patients who died during their hospital stay after surgery were considered to have lost their ability to live independently.…”

Section: Definitions Of Exposure and Outcomesmentioning

confidence: 99%

Preoperative Treatment of Severe Diabetes Mellitus and Hypertension Mitigates Healthcare Disparities and Prevents Adverse Postoperative Discharge to a Nursing Home

Wachtendorf¹,

Azimaraghi²,

Rangasamy³

et al. 2022

Annals of Surgery

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Objective: To evaluate whether patients of Black race are at higher risk of adverse postoperative discharge to a nursing home, and if a higher prevalence of severe diabetes mellitus and hypertension are contributing. Background: It is unclear whether a patient's race predicts adverse discharge to a nursing home after surgery, and if preexisting diseases are contributing. Methods: A total of 368,360 adults undergoing surgery between 2007 and 2020 across 2 academic healthcare networks in New England were included. Patients of self-identified Black or White race were compared. The primary outcome was postoperative discharge to a nursing facility. Mediation analysis was used to examine the impact of preexisting severe diabetes mellitus and hypertension on the primary association.Results: In all, 10.3% (38,010/368,360) of patients were Black and 26,434 (7.2%) patients were discharged to a nursing home. Black patients were at increased risk of postoperative discharge to a nursing facility (adjusted absolute risk difference: 1.9%; 95% confidence interval: 1.6%-2.2%; P < 0.001). A higher prevalence of preexisting severe diabetes mellitus and hypertension in Black patients mediated 30.2% and 15.6% of this association. Preoperative medication-based treatment adherent to guidelines in patients with severe diabetes mellitus or hypertension mitigated the primary association (P-for-interaction <0.001). The same pattern of effect mitigation by pharmacotherapy was observed for the endpoint 30-day readmission. Conclusions: Black race was associated with postoperative discharge to a nursing facility compared to White race. Optimized preoperative assessment and treatment of diabetes mellitus and hypertension improves surgical outcomes and provides an opportunity to the surgeon to help eliminate healthcare disparities.

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Section: Definitions Of Exposure and Outcomesmentioning

confidence: 99%

Preoperative Treatment of Severe Diabetes Mellitus and Hypertension Mitigates Healthcare Disparities and Prevents Adverse Postoperative Discharge to a Nursing Home

Wachtendorf¹,

Azimaraghi²,

Rangasamy³

et al. 2022

Annals of Surgery

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“…We also analysed changes among admitted patients in adverse discharge disposition, which we define as discharge to a skilled nursing facility of a patient who lived at home prior to hospital admission. 7 We used multivariable logistic regression analyses adjusted for age, sex, body mass index, Charlson Comorbidity Index, race, and ethnicity for calculating the adjusted odds ratios (aOR) and absolute adjusted risk differences (aARD).…”

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confidence: 99%

Should asymptomatic patients testing positive for SARS-CoV-2 wait for elective surgical procedures?

Lieberman

Racine

Nair

et al. 2022

British Journal of Anaesthesia

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Hispanic/Latino Ethnicity and Loss of Post-Surgery Independent Living: A Retrospective Cohort Study from a Bronx Hospital Network

Witt,

Rudolph,

Sterling

et al. 2024

Anesthesia &Amp; Analgesia

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BACKGROUND: Black race is associated with postoperative adverse discharge to a nursing facility, but the effects of Hispanic/Latino ethnicity are unclear. We explored the Hispanic paradox, described as improved health outcomes among Hispanic/Latino patients on postoperative adverse discharge to nursing facility. METHODS: A total of 93,356 adults who underwent surgery and were admitted from home to Montefiore Medical Center in the Bronx, New York, between January 2016 and June 2021 were included. The association between self-identified Hispanic/Latino ethnicity and the primary outcome, postoperative adverse discharge to a nursing home or skilled nursing facility, was investigated. Interaction analysis was used to examine the impact of socioeconomic status, determined by estimated median household income and insurance status, on the primary association. Mixed-effects models were used to evaluate the proportion of variance attributed to the patient’s residential area defined by zip code and self-identified ethnicity. RESULTS: Approximately 45.9% (42,832) of patients identified as Hispanic/Latino ethnicity and 9.7% (9074) patients experienced postoperative adverse discharge. Hispanic/Latino ethnicity was associated with lower risk of adverse discharge (relative risk [RRadj] 0.88; 95% confidence interval [CI], 00.82–0.94; P < .001), indicating a Hispanic Paradox. This effect was modified by the patient’s socioeconomic status (P-for-interaction <.001). Among patients with a high socioeconomic status, the Hispanic paradox was abolished (RRadj 1.10; 95% CI, 11.00–1.20; P = .035). Furthermore, within patients of low socioeconomic status, Hispanic/Latino ethnicity was associated with a higher likelihood of postoperative discharge home with health services compared to non-Hispanic/Latino patients (RRadj 1.06; 95% CI, 11.01–1.12; P = .017). CONCLUSIONS: Hispanic/Latino ethnicity is a protective factor for postoperative adverse discharge, but this association is modified by socioeconomic status. Future studies should focus on postoperative discharge disposition and socioeconomic barriers in patients with Hispanic/Latino ethnicity.

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Association of surgery type and duration of hospitalisation with the ability to live independently after surgery

Cited by 3 publications

References 11 publications

Preoperative Treatment of Severe Diabetes Mellitus and Hypertension Mitigates Healthcare Disparities and Prevents Adverse Postoperative Discharge to a Nursing Home

Preoperative Treatment of Severe Diabetes Mellitus and Hypertension Mitigates Healthcare Disparities and Prevents Adverse Postoperative Discharge to a Nursing Home

Should asymptomatic patients testing positive for SARS-CoV-2 wait for elective surgical procedures?

Hispanic/Latino Ethnicity and Loss of Post-Surgery Independent Living: A Retrospective Cohort Study from a Bronx Hospital Network

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