Christy E Cauley1,2, David C Chang3, Stuart R Lipsitz4,5, Mary Brindle3,4, Zara Cooper5,6,7, Christine S Ritchie8. 1. Department of Surgery, Massachusetts General Hospital, Harvard Medical School, 15 Parkman St., WACC 460, Boston, MA, 02114, USA. ccauley@mgh.harvard.edu. 2. Ariadne Labs, Brigham and Women's Hospital, Harvard. T.H. School of Public Health, Boston, MA, USA. ccauley@mgh.harvard.edu. 3. Department of Surgery, Massachusetts General Hospital, Harvard Medical School, 15 Parkman St., WACC 460, Boston, MA, 02114, USA. 4. Ariadne Labs, Brigham and Women's Hospital, Harvard. T.H. School of Public Health, Boston, MA, USA. 5. The Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA. 6. Marcus Institute for Aging Research, Boston, MA, USA. 7. Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA. 8. Mongan Institute Center for Aging and Serious Illness, Massachusetts General Hospital, Boston, MA, USA.
Abstract
BACKGROUND: Older adults often prioritize independence and time spent at home when making major treatment decisions. Identifying preoperative predictors of non-home discharge (i.e., requiring institutional discharge rather than home), among adults undergoing elective diverticulitis surgery, can support surgical decision-making and expectation management. This study aims to (1) examine rates of non-home discharge after elective surgery for diverticulitis and (2) identify predictors of non-home discharge. METHODS: This is a multi-institutional cohort study of National Surgical Quality Improvement Program Database. Patients over 18 years who underwent colon resection with diagnosis of diverticulitis were included. Clinical and demographic information were collected by trained nurse reviewers. Emergency operations were excluded. Patients with home versus non-home discharge were compared and predictors identified using multivariable regression. RESULTS: Between 2016 and 2019, 40,912 patients were identified. Mean age was 58.5 years (SD = 12.58) with 48.5% 60 + years and 17.7% of patients 70 + years old. The majority (55.9%) were female and "White" race (83.5%). Most patients underwent colectomy without ostomy (88.4%). Nine percent of patients over age 60 had non-home discharge. Functional dependence preoperatively was strongly associated with non-home discharge. On multivariable analysis, significant predictors of non-home discharge were preoperative functional dependence (OR 28.2; 95% CI 9.8-81.7), advancing chronologic age (age 80 + : OR 22.4; 95% CI 18.6-26.9), and preoperative albumin < 3.0 (OR 4.0; 95% CI 3.4-4.6). CONCLUSIONS: Nearly one in ten patients over 60 years was not discharged home after elective diverticulitis surgery. Preoperative functional status predicts non-home discharge. Future studies need to assess potentially modifiable causes of non-home discharge, such as social support.
BACKGROUND: Older adults often prioritize independence and time spent at home when making major treatment decisions. Identifying preoperative predictors of non-home discharge (i.e., requiring institutional discharge rather than home), among adults undergoing elective diverticulitis surgery, can support surgical decision-making and expectation management. This study aims to (1) examine rates of non-home discharge after elective surgery for diverticulitis and (2) identify predictors of non-home discharge. METHODS: This is a multi-institutional cohort study of National Surgical Quality Improvement Program Database. Patients over 18 years who underwent colon resection with diagnosis of diverticulitis were included. Clinical and demographic information were collected by trained nurse reviewers. Emergency operations were excluded. Patients with home versus non-home discharge were compared and predictors identified using multivariable regression. RESULTS: Between 2016 and 2019, 40,912 patients were identified. Mean age was 58.5 years (SD = 12.58) with 48.5% 60 + years and 17.7% of patients 70 + years old. The majority (55.9%) were female and "White" race (83.5%). Most patients underwent colectomy without ostomy (88.4%). Nine percent of patients over age 60 had non-home discharge. Functional dependence preoperatively was strongly associated with non-home discharge. On multivariable analysis, significant predictors of non-home discharge were preoperative functional dependence (OR 28.2; 95% CI 9.8-81.7), advancing chronologic age (age 80 + : OR 22.4; 95% CI 18.6-26.9), and preoperative albumin < 3.0 (OR 4.0; 95% CI 3.4-4.6). CONCLUSIONS: Nearly one in ten patients over 60 years was not discharged home after elective diverticulitis surgery. Preoperative functional status predicts non-home discharge. Future studies need to assess potentially modifiable causes of non-home discharge, such as social support.