Factors Associated With Days Away From Home in the Year After Major Surgery Among Community-living Older Persons

Abstract

Objective: To identify the factors associated with days away from home in the year after hospital discharge for major surgery. Background: Relatively little is known about which older persons are susceptible to spending a disproportionate amount of time in hospitals and other health care facilities after major surgery. Methods: From a cohort of 754 community-living persons, aged 70+ years, 394 admissions for major surgery were identified from 289 participants who were discharged from the hospital. Candidate risk factors were assessed every 18 months. Days away from home were calculated as the number of days spent in a health care facility. Results: In the year after major surgery, the mean (SD) and median (interquartile range) number of days away from home were 52.0 (92.2) and 15 (0–51). In multivariable analysis, 5 factors were independently associated with the number of days away from home: age 85 years and older, low score on the Short Physical Performance Battery, low peak expiratory flow, low functional self-efficacy, and musculoskeletal surgery. Based on the presence versus absence of these factors, the absolute mean differences in the number of days away from home ranged from 31.2 for age 85 years and older to 53.5 for low functional self-efficacy. Conclusions: The 5 independent risk factors can be used to identify older persons who are particularly susceptible to spending a disproportionate amount of time away from home after major surgery, and a subset of these factors can also serve as targets for interventions to improve quality of life by reducing time spent in hospitals and other health care facilities.

Relationship Between Distressing Symptoms and Changes in Disability After Major Surgery Among Community-living Older Persons

“…As in prior studies, 5,33,34 covariates in the adjusted analysis included age, sex, race/ethnicity, fee-for-service Medicare, frailty, cognitive impairment, number of disabilities before surgery, length of hospital stay, time since the prior comprehensive assessment, and number of the specific 18-month interval (to account for calendar time). The results were compared between subgroups defined on the basis of the timing of surgery (elective vs nonelective), sex, multimorbidity, and socioeconomic disadvantage at the individual and neighborhood levels; and formal tests of statistical interaction were run to determine whether the associations differed between the corresponding subgroups.…”

“…The posthospital period provides an unparalleled opportunity to identify and palliate distressing symptoms, largely because nearly all older patients are scheduled for routine follow-up visits shortly after their major surgery. Despite the high prevalence of distressing symptoms after hospital discharge for major surgery, 5 palliative care is provided almost exclusively in hospitals, hospice, and cancer centers 35 . One impediment to the expansion of palliative care beyond these settings is uncertainty about the extent to which distressing symptoms are associated with adverse functional outcomes.…”

“…In this vulnerable population, major surgery is a common 3 and serious 4 health event that has pronounced deleterious effects on both distressing symptoms and functional outcomes. In a recent study, we found that the occurrence and mean number of distressing symptoms increase substantially in the 6 months after major surgery 5 . In prior work, we have shown that the number of disabilities in essential, instrumental and mobility activities also increases substantially after major surgery 6 .…”

“…In a recent study, we found that the occurrence and mean number of distressing symptoms increase substantially in the 6 months after major surgery. 5 In prior work, we have shown that the number of disabilities in essential, instrumental and mobility activities also increases substantially after major surgery. 6 Little is known, however, about the relationship between distressing symptoms and the course of disability after major surgery.…”

Surgical outcomes and healthcare expenditures among patients with dementia undergoing major surgery

“…2,3 This demographic transition has created significant healthcare challenges, as older individuals are more susceptible to diseases and at risk for suboptimal clinical outcomes due to age-related comorbid conditions, such as Alzheimer's disease and related dementias (ADRD). 4,5 ADRD encompasses a broad range of cognitive deficiencies that may result in memory deficits, functional decline, delirium, and reduced rehabilitation potential, ultimately leading to poor outcomes. 5,6 Surgical procedures among older individuals have increased over the last several decades, with approximately 1 in 8 elderly individuals requiring surgery.…”