Preoperative functional status is associated with discharge to nonhome in geriatric individuals

Abstract

Introduction Discharging older individuals to rehabilitation facilities is associated with adverse outcomes, including readmission or increased mortality rate. As preoperative functional status is an important factor impacting patient outcome, we hypothesized that this would be associated with patient disposition to nonhome locations. Materials and Methods A retrospective analysis was performed using data from the 2013–2018 American College of Surgeons National Surgical Quality Improvement Program, including targeted variables from the Geriatric Pilot Project. Patients aged 65 and older in 33 institutions across the nation were included (n = 44,219). Preoperative functional status was categorized as independent, partially dependent, and dependent. The primary outcome was home versus nonhome disposition. Nonhome was defined as rehabilitation facility and nursing home. Descriptive analyses were performed. Variables associated with postoperative discharge to nonhome were identified using logistic regression. Results The largest percentage of operations was orthopedics (40.8%), followed by general surgery (29.2%) and vascular operations (10.0%). The majority of the patients were independent before operations (93.1% independent, 6% partially dependent, and 0.9% totally dependent). In regression analyses, patients who were partially dependent preoperatively had five times higher odds of discharging to nonhome, compared to patients who were independent (odds ratio [OR] 5.04, p < 0.01). Similarly, patients who were totally dependent had 3.2 higher odds of discharging to nonhome than patients who were independent (OR 3.22, p < 0.01). Conclusion Better preoperative functional status is associated with patient discharge to home in older adults. Preoperative interventions aimed at improving functional status, such as prehabilitation, may be beneficial in improving patient outcomes.

Prognostic Significance of Baseline Frailty Status in Traumatic Spinal Cord Injury

“…Importantly, this study only evaluated multivariable associations of frailty with mortality and not with other discharge dispositions which have previously been shown to serve as reliable surrogates for degree of functional status impairment at the conclusion of hospitalization. 25 Insofar as routine discharge disposition to home represents a favorable functional status and substantive recovery, a potential mechanistic explanation for the findings of our analysis includes underdeveloped microcirculation and decreased perfusion capacity as well as neuronal abnormalities in frail patients. The relationship Components of the mFI-11 were each assigned a value of "1" and summed for each patient to create a composite score (maximum value 11).…”

An Analysis of Postoperative Complications in Medialization Thyroplasty: NSQIP Data

“…Hung et al [17] used NSQIP from 2013 to 2019 and found that geriatric patients (65 years and above) and patients who had a partially dependent preoperative functional status were discharged to rehabilitation facilities or nursing homes significantly more often than those with an independent functional status [17]. The presence of these preoperative factors therefore contributes to an increased length of stay.…”