Anghela Z Paredes1, Azeem T Malik2, Marcus Cluse3, Scott A Strassels3, Heena P Santry3, Daniel Eiferman3, Christian Jones4, Daniel Vazquez3. 1. Department of Surgery, Division of Critical Care, Trauma, and Burn, The Ohio State University Wexner Medical Center, Columbus. Electronic address: Anghela.Paredes@osumc.edu. 2. Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus. 3. Department of Surgery, Division of Critical Care, Trauma, and Burn, The Ohio State University Wexner Medical Center, Columbus. 4. Department of Surgery, Division of Acute Care Surgery, Johns Hopkins Medicine, Baltimore, MD.
Abstract
BACKGROUND: Emergency general surgery can have a profound impact on the functional status of even previously independent patients. The role and influence of discharging a patient to a skilled nursing facility, however, remains largely unknown. METHODS: We queried the American College of Surgeons National Surgical Quality Improvement Program for community-dwelling adults who underwent 1 of 7 emergency general surgery procedures and were discharged home or to a skilled nursing facility from 2012 to 2016. Propensity score matching and multivariable regression analyses were performed to determine the relationship between discharge disposition and outcomes. RESULTS: Overall, 140,922 patients met the inclusion criteria. The majority were discharged home (95.9%). After applying 1:1 propensity score matching, in comparison to patients discharged home, individuals discharged to a skilled nursing facility had a greater odds of respiratory (odds ratio 2.32; 95% confidence interval, 1.59-3.38) and septic complications (odds ratio 1.63, 95% confidence interval 1.12-2.36) after discharge. Furthermore, following surgery, individuals discharged to a skilled nursing facility had a greater odds of 30-day readmission (odds ratio 1.14; 95% confidence interval, 1.01-1.29), and death within 30 days of the procedure (odds ratio 2.07; 95% confidence interval, 1.65-2.61). CONCLUSION: After accounting for patient severity and perioperative course, discharge to a skilled nursing facility is an independent risk factor for death, readmission, and postdischarge complications.
BACKGROUND: Emergency general surgery can have a profound impact on the functional status of even previously independent patients. The role and influence of discharging a patient to a skilled nursing facility, however, remains largely unknown. METHODS: We queried the American College of Surgeons National Surgical Quality Improvement Program for community-dwelling adults who underwent 1 of 7 emergency general surgery procedures and were discharged home or to a skilled nursing facility from 2012 to 2016. Propensity score matching and multivariable regression analyses were performed to determine the relationship between discharge disposition and outcomes. RESULTS: Overall, 140,922 patients met the inclusion criteria. The majority were discharged home (95.9%). After applying 1:1 propensity score matching, in comparison to patients discharged home, individuals discharged to a skilled nursing facility had a greater odds of respiratory (odds ratio 2.32; 95% confidence interval, 1.59-3.38) and septic complications (odds ratio 1.63, 95% confidence interval 1.12-2.36) after discharge. Furthermore, following surgery, individuals discharged to a skilled nursing facility had a greater odds of 30-day readmission (odds ratio 1.14; 95% confidence interval, 1.01-1.29), and death within 30 days of the procedure (odds ratio 2.07; 95% confidence interval, 1.65-2.61). CONCLUSION: After accounting for patient severity and perioperative course, discharge to a skilled nursing facility is an independent risk factor for death, readmission, and postdischarge complications.
Authors: Dara L Horn; Jolie Shen; Emma Roberts; Theresa N Wang; Kevin S Li; Grant E O'Keefe; Joseph Cuschieri; Eileen M Bulger; Bryce R H Robinson Journal: J Trauma Acute Care Surg Date: 2020-07 Impact factor: 3.697
Authors: Rebecca A Burmeister; Christine Jarocki; Crystal M Holmes; Gary M Rothenberg; Michael E Munson; Brian M Schmidt Journal: Int Wound J Date: 2021-05-02 Impact factor: 3.315