Jason W Smith1, Jennifer Knight Davis2, Catherine C Quatman-Yates3, Brittany L Waterman4, Scott A Strassels5,6, Jen D Wong7,8, Victor K Heh5,6, Holly E Baselice5,6, Guy N Brock5,6,9, Brian C Clark10,11,12, John F P Bridges5,6,9, Heena P Santry5,6. 1. Department of Surgery, University of Louisville, Louisville, Kentucky. 2. Department of Surgery, West Virginia University, Morgantown, West Virginia. 3. Division of Physical Therapy, Ohio State University, Columbus, Ohio. 4. Department of Internal Medicine, Ohio State University Wexner Medical Center, Columbus, Ohio. 5. Department of Surgery, Ohio State University Wexner Medical Center, Columbus, Ohio. 6. Center for Surgical Health Assessment, Research, & Policy, Ohio State University, Columbus, Ohio. 7. Department of Human Sciences, Ohio State University, Columbus, Ohio. 8. Office of Geriatrics and Inter-professional Aging Studies, Ohio State University, Columbus, Ohio. 9. Department of Biomedical Informatics, Ohio State University, Columbus, Ohio. 10. Ohio Musculoskeletal and Neurological Institute, Ohio University, Athens, Ohio. 11. Department of Biomedical Sciences, Ohio University, Athens, Ohio. 12. Division of Geriatric Medicine, Ohio University, Athens, Ohio.
Abstract
OBJECTIVES: To examine loss of community-dwelling status 9 months after hospitalization for high-acuity emergency general surgery (HA-EGS) disease among older Americans. DESIGN: Retrospective analysis of claims data. SETTING: US communities with Medicare beneficiaries. PARTICIPANTS: Medicare beneficiaries age 65 years or older hospitalized urgently/emergently between January 1, 2015, and March 31, 2015, with a principal diagnosis representing potential life or organ threat (necrotizing soft tissue infections, hernias with gangrene, ischemic enteritis, perforated viscus, toxic colitis or gastroenteritis, peritonitis, intra-abdominal hemorrhage) and an operation of interest on hospital days 1 or 2 (N = 3319). MEASUREMENTS: Demographic characteristics (age, race, and sex), comorbidities, principal diagnosis, complications, and index hospitalization disposition (died; discharged to skilled nursing facility [SNF], long-term acute care [LTAC], rehabilitation, hospice, home (with or without services), or acute care hospital; other) were measured. Survivors of index hospitalization were followed until December 31, 2015, on mortality and community-dwelling status (SNF/LTAC vs not). Descriptive statistics, Kaplan-Meier plots, and χ2 tests were used to describe and compare the cohort based on disposition. A multivariable logistic regression model, adjusted for age, sex, comorbidities, complications, and discharge disposition, determined independent predictors of loss of community-dwelling status at 9 months. RESULTS: A total of 2922 (88%) survived index hospitalization. Likelihood of discharge to home decreased with increasing age, baseline comorbidities, and in-hospital complications. Overall, 418 (14.3%) HA-EGS survivors died during the follow-up period. Among those alive at 9 months, 10.3% were no longer community dwelling. Initial discharge disposition to any location other than home and three or more surgical complications during index hospitalization were independent predictors of residing in a SNF/LTAC 9 months after surviving HA-EGS. CONCLUSION: Older Americans, known to prioritize living in the community, will experience substantial loss of independence due to HA-EGS. Long-term expectations after surviving HA-EGS must be framed from the perspective of the outcomes that older patients value the most. Further research is needed to examine the quality-of-life burden of EGS survivorship prospectively. J Am Geriatr Soc 67:2289-2297, 2019.
OBJECTIVES: To examine loss of community-dwelling status 9 months after hospitalization for high-acuity emergency general surgery (HA-EGS) disease among older Americans. DESIGN: Retrospective analysis of claims data. SETTING: US communities with Medicare beneficiaries. PARTICIPANTS: Medicare beneficiaries age 65 years or older hospitalized urgently/emergently between January 1, 2015, and March 31, 2015, with a principal diagnosis representing potential life or organ threat (necrotizing soft tissue infections, hernias with gangrene, ischemic enteritis, perforated viscus, toxic colitis or gastroenteritis, peritonitis, intra-abdominal hemorrhage) and an operation of interest on hospital days 1 or 2 (N = 3319). MEASUREMENTS: Demographic characteristics (age, race, and sex), comorbidities, principal diagnosis, complications, and index hospitalization disposition (died; discharged to skilled nursing facility [SNF], long-term acute care [LTAC], rehabilitation, hospice, home (with or without services), or acute care hospital; other) were measured. Survivors of index hospitalization were followed until December 31, 2015, on mortality and community-dwelling status (SNF/LTAC vs not). Descriptive statistics, Kaplan-Meier plots, and χ2 tests were used to describe and compare the cohort based on disposition. A multivariable logistic regression model, adjusted for age, sex, comorbidities, complications, and discharge disposition, determined independent predictors of loss of community-dwelling status at 9 months. RESULTS: A total of 2922 (88%) survived index hospitalization. Likelihood of discharge to home decreased with increasing age, baseline comorbidities, and in-hospital complications. Overall, 418 (14.3%) HA-EGS survivors died during the follow-up period. Among those alive at 9 months, 10.3% were no longer community dwelling. Initial discharge disposition to any location other than home and three or more surgical complications during index hospitalization were independent predictors of residing in a SNF/LTAC 9 months after surviving HA-EGS. CONCLUSION: Older Americans, known to prioritize living in the community, will experience substantial loss of independence due to HA-EGS. Long-term expectations after surviving HA-EGS must be framed from the perspective of the outcomes that older patients value the most. Further research is needed to examine the quality-of-life burden of EGS survivorship prospectively. J Am Geriatr Soc 67:2289-2297, 2019.
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