Gildasio S De Oliveira1, Jane L Holl2, Lee Ann Lindquist3, Nicholas J Hackett3, John Y S Kim4, Robert J McCarthy1. 1. Department of Anesthesiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois. 2. Center for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago, Illinois. 3. Division of Geriatrics, Department of Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois. 4. Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
Abstract
OBJECTIVES: To evaluate whether age is independently associated with greater rate of unanticipated hospital admission within 30 days of ambulatory surgery. DESIGN: Retrospective database study. SETTING: The 2012 National Surgical Quality Improvement Project data set. PARTICIPANTS: All individuals with "outpatient" recorded as their status in the data set. MEASUREMENTS: The primary outcome of interest was all-cause hospital admission in the 30-day period after surgery. Multivariate models were constructed to control for covariate bias. Assessment of interactions of terms in the final model was performed using a conditional tree analysis. RESULTS: The final analysis included 53,667 ambulatory surgical cases. There were 1,370 (2.5%, 99% confidence interval (CI) = 2.4-2.7%) hospital admissions among the cases evaluated. After adjusting for potential confounders, age (<70 vs ≥70) was independently associated with hospital admission (odds ratio = 1.54, 99% CI = 1.29-1.84). A classification tree analysis of the cases without postoperative morbidity identified age (<60 vs ≥60) as an important decision point leading to greater likelihood of admission (P < .001) within 30 days after ambulatory surgery. CONCLUSION: Even after adjusting for comorbidities, older adults are at greater risk of unanticipated hospital admission within 30 days of ambulatory surgery. Renal failure, chronic obstructive pulmonary disease, current cancer treatment, diabetes mellitus, and history of amputation or revascularization were also associated with greater likelihood of hospital admission. Interventions to improve transitions of care for older adults after ambulatory surgery are needed.
OBJECTIVES: To evaluate whether age is independently associated with greater rate of unanticipated hospital admission within 30 days of ambulatory surgery. DESIGN: Retrospective database study. SETTING: The 2012 National Surgical Quality Improvement Project data set. PARTICIPANTS: All individuals with "outpatient" recorded as their status in the data set. MEASUREMENTS: The primary outcome of interest was all-cause hospital admission in the 30-day period after surgery. Multivariate models were constructed to control for covariate bias. Assessment of interactions of terms in the final model was performed using a conditional tree analysis. RESULTS: The final analysis included 53,667 ambulatory surgical cases. There were 1,370 (2.5%, 99% confidence interval (CI) = 2.4-2.7%) hospital admissions among the cases evaluated. After adjusting for potential confounders, age (<70 vs ≥70) was independently associated with hospital admission (odds ratio = 1.54, 99% CI = 1.29-1.84). A classification tree analysis of the cases without postoperative morbidity identified age (<60 vs ≥60) as an important decision point leading to greater likelihood of admission (P < .001) within 30 days after ambulatory surgery. CONCLUSION: Even after adjusting for comorbidities, older adults are at greater risk of unanticipated hospital admission within 30 days of ambulatory surgery. Renal failure, chronic obstructive pulmonary disease, current cancer treatment, diabetes mellitus, and history of amputation or revascularization were also associated with greater likelihood of hospital admission. Interventions to improve transitions of care for older adults after ambulatory surgery are needed.
Authors: Charles A Goldfarb; Michael G Rizzo; Brandon L Rogalski; Anchal Bansal; Christopher J Dy; Robert H Brophy Journal: J Bone Joint Surg Am Date: 2018-12-19 Impact factor: 5.284
Authors: Elise A Dasinger; Westyn Branch-Elliman; Steven D Pizer; Hassen Abdulkerim; Amy K Rosen; Martin P Charns; Mary T Hawn; Kamal M F Itani; Hillary J Mull Journal: Am J Surg Date: 2019-01-04 Impact factor: 2.565
Authors: Kara A Rothenberg; Jordan R Stern; Elizabeth L George; Amber W Trickey; Arden M Morris; Daniel E Hall; Jason M Johanning; Mary T Hawn; Shipra Arya Journal: JAMA Netw Open Date: 2019-05-03