Time Spent Away from Home in the Year Following High‐Risk Cancer Surgery in Older Adults

Abstract

OBJECTIVES To understand where older adults spend time (at home, in the hospital, or in a nursing home) in the year following high‐risk cancer surgery. DESIGN Retrospective cohort study. SETTING Medicare beneficiaries using data from Medicare Inpatient claims to ascertain hospital days and the Minimum Data Set to ascertain nursing home days. PARTICIPANTS Beneficiaries who underwent high‐risk cancer surgery (cystectomy, pancreaticoduodenectomy, gastrectomy, or esophagectomy) were identified to determine cumulative time spent away from home in the year following surgery. MEASUREMENTS Adjusted percentages of time spent away from home (ie, days in a hospital or nursing home) were modeled for the year following surgery. RESULTS A total of 37 748 beneficiaries underwent high‐risk cancer surgery during the study period, and 28.3% died within 1 year. Overall, beneficiaries spent 13.9 ± 26.2 days in the hospital (over 1.5 ± 2.0 hospital readmissions) and 37.2 ± 50.6 days in the nursing home (over 1.5 ± 1.0 admissions) in the year following surgery. Among beneficiaries who were alive and dead at 1 year, 18.5% and 30.1% of time was spent away from home, respectively. Beneficiaries who were initially discharged to a facility following surgery and died within 1 year spent 44.4% of their final year away from home. CONCLUSION Time spent away from home in the hospital and/or nursing home in the year following high‐risk cancer surgery is substantial among Medicare beneficiaries. This information is crucial in counseling patients on postoperative expectations and may additionally influence preoperative decision making. J Am Geriatr Soc 68:505–510, 2020

Incorporating Outcomes that Matter to Older Adults into Surgical Research

“…For example, two recent publications studied the new patient-oriented outcome of time spent away from home following emergency general surgery and high-risk cancer surgery. 12,13 The authors of the current study demonstrated the utility of baseline frailty measures for predicting hospital-acquired geriatric syndromes. Hospital-acquired geriatric syndromes are detrimental to both traditional outcomes, such as mortality, and longer-term outcomes valued by older adults, such as maintaining independence (Figure 1).…”

“…In response to this practical need for more data about geriatric‐focused predictors and outcomes for older surgical patients, the current study and other recent studies have focused on important patient‐centered outcomes. For example, two recent publications studied the new patient‐oriented outcome of time spent away from home following emergency general surgery and high‐risk cancer surgery 12,13 …”

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