Which Patients Require More Care after Hospital Discharge? An Analysis of Post-Acute Care Use among Elderly Patients Undergoing Elective Surgery

Sacks, Greg D.; Lawson, Elise H.; Dawes, Aaron J.; Gibbons, Melinda M.; Zingmond, David S.; Ko, Clifford Y.

doi:10.1016/j.jamcollsurg.2015.02.029

Cited by 70 publications

(59 citation statements)

References 19 publications

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“…In our study, cystectomy was associated with a higher use of non-home discharges than any other urologic procedure except large TURBT. However, this number is lower than other types of non-urologic procedures among older adults, such as colectomy (40%), pancreatectomy (46%), open abdominal aortic aneurysm repair (45%), 19 and hip fracture surgery (35%). 4 While the reason behind the lower discharge rates to skilled and assisted living facilities among urologic procedures compared to these non-urologic procedures is beyond the scope of this study, some hypotheses may include that urologic patients are healthier, that urologic procedures are well tolerated by older individuals, or that urologists may be underutilizing post operative care in such facilities.…”

Section: Discussionmentioning

confidence: 91%

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Preoperative Frailty Is Associated With Discharge to Skilled or Assisted Living Facilities After Urologic Procedures of Varying Complexity

Suskind

Jin

Cooperberg

et al. 2016

Urology

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Purpose To evaluate the association between frailty and post-operative discharge destination after different types of commonly performed urologic procedures in older patients. Materials and Methods Using data from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) from 2011–2013, we identified commonly performed inpatient urologic procedures among patients age 65 and older. We then assessed the effect of frailty, measured by the NSQIP Frailty Index (NSQIP-FI), on discharge to a skilled or assisted living facility using logistic regression and assessed the heterogeneity of this effect across procedures using two-level random effects modeling. Results Overall, 1,144 out of 20,794 (5.5%) urologic cases, representing 19 different procedures, resulted in discharge to a skilled or assisted living facility. Cystectomy and large TURBT had the highest percentage at 16.3%. 25% of patients undergoing urology procedures were frail (NSQIP-frailty index [FI] 0.18+), including 9.8% of patients discharged to a facility. Even after adjustment for year, age, race, type of anesthesia, smoking status, recent weight loss, and whether or not the procedure was elective, frailty was strongly associated with discharge to a facility [adjusted OR 3.1 (96% CI 2.5, 3.8) for NSQIP-FI 0.18+ compared to NSQIP FI 0]. This finding was consistent across most procedures of varying complexity with an overall effect of OR 1.6 (95% CI 1.5, 2.0). Conclusions Increasing frailty is associated with discharge to a skilled or assisted living facility across most inpatient urologic procedures evaluated, regardless of complexity. This information is important for preoperative counseling with patients undergoing urologic surgery.

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Section: Discussionmentioning

confidence: 91%

“…10 Advanced age, poor functional status, and inpatient complications were also strongly associated with non-home discharges among patients undergoing colectomy, pancreatectomy, and open abdominal aortic aneurysm repair. 19 …”

Section: Discussionmentioning

confidence: 99%

Preoperative Frailty Is Associated With Discharge to Skilled or Assisted Living Facilities After Urologic Procedures of Varying Complexity

Suskind

Jin

Cooperberg

et al. 2016

Urology

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“…Whereas much of the focus on improving outcomes and minimizing variation after surgery has been placed on short-term measures such as morbidity, failure-to-rescue, and mortality, discharge disposition has only recently been scrutinized as an outcome or a quality measure. 4,12,17 The magnitude of the problem presented herein is striking and has implications for care coordination and payment reform strategies. Medicare payments for postacute care have grown faster than most other spending categories.…”

Section: Discussionmentioning

confidence: 99%

“…6,18 We specifically focus on urgent and emergent colectomy, as these patients are more likely to require some form of postacute care. 12 Because these operations are performed for life-threatening conditions, patients are more likely to undergo surgery at the nearest hospital and closer to home. This also minimizes underlying referral pattern biases and patient selection of which hospitals they choose for care, which are often encountered in the elective setting.…”

Section: Discussionmentioning

confidence: 99%

Hospital Ownership of a Postacute Care Facility Influences Discharge Destinations After Emergent Surgery

et al. 2016

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“…Colorectal cancer (CRC) is a disease of the elderly and requires complex surgery, often with additional chemotherapy or radiation, for definitive treatment . An estimated 30% to 42% of patients are discharged to post‐acute care after undergoing surgery for CRC …”

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confidence: 99%

Post‐Acute Care among Older Adults with Stage I to III Colorectal Cancer

Kenzik

Williams

Bhatia

et al. 2018

J American Geriatrics Society

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BACKGROUND Little information is available on the long‐term use of post‐acute care among older patients with colorectal cancer (CRC), relative to individuals without cancer. This study examines the use of post‐acute care among older cancer survivors (>65 y) with CRC and compares it with noncancer patients up to 5 years from surgery. DESIGN Retrospective cohort. SETTING SEER‐Medicare. PARTICIPANTS Patients treated for stage I to III CRC between January 1, 2000, and December 31, 2011 (n = 40 812) and noncancer Medicare beneficiaries hospitalized for noncancer treatment matching on age, sex, race, comorbidity, and Medicaid dual eligibility. MEASUREMENTS Incident post‐acute care claims (skilled nursing, long‐term care facility, and home health) from 0 to 100 days, 101 to 365 days, and 1 to 5 years from hospitalization. RESULTS The median age was 77 years. All patients had surgery, 34% received chemotherapy, and 27% received surgery and adjuvant therapy. The cumulative incidence of any post‐acute care within 100 days of hospitalization was 45.7% for stage III, 37.9% for stage I/II, and 39% for controls (p < .001). Within the CRC cohort only, the cumulative incidence of post‐acute care was 2.9% (stage I/II) and 4.2% (stage III, p < .001) from 101 to 365 days and 15.8% (stage I/II) and 16.9% (stage III, p < .001) from 1 to 5 years. Increasing age, ostomies, and neoadjuvant or adjuvant therapy were associated with increased hazard of all post‐acute patients within 100 days from hospitalization. From 1 to 5 years from diagnosis, adjuvant therapy was associated with greater exclusive home health care use. CONCLUSIONS Survivorship planning among older CRC patients should include discussions of post‐acute care following cancer therapy, even several years after treatment. J Am Geriatr Soc 67:937–944, 2019.

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Which Patients Require More Care after Hospital Discharge? An Analysis of Post-Acute Care Use among Elderly Patients Undergoing Elective Surgery

Cited by 70 publications

References 19 publications

Preoperative Frailty Is Associated With Discharge to Skilled or Assisted Living Facilities After Urologic Procedures of Varying Complexity

Preoperative Frailty Is Associated With Discharge to Skilled or Assisted Living Facilities After Urologic Procedures of Varying Complexity

Hospital Ownership of a Postacute Care Facility Influences Discharge Destinations After Emergent Surgery

Post‐Acute Care among Older Adults with Stage I to III Colorectal Cancer

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