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Loss of Community-Dwelling Status Among Survivors of High-Acuity Emergency General Surgery Disease.

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.

journal_name

J Am Geriatr Soc

journal_title

Journal of the American Geriatrics Society

authors

Smith JW,Knight Davis J,Quatman-Yates CC,Waterman BL,Strassels SA,Wong JD,Heh VK,Baselice HE,Brock GN,Clark BC,Bridges JFP,Santry HP

doi

10.1111/jgs.16046

subject

Has Abstract

pub_date

2019-11-01 00:00:00

pages

2289-2297

issue

eissn

0002-8614

issn

1532-5415

journal_volume

pub_type

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Loss of Community-Dwelling Status Among Survivors of High-Acuity Emergency General Surgery Disease.