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The Significance of Discharge to Skilled Care After Abdominopelvic Surgery in Older Adults

Legner, Victor J. MD*; Massarweh, Nader N. MD; Symons, Rebecca G. MPH; McCormick, Wayne C. MD, MPH*; Flum, David R. MD, MPH

doi: 10.1097/SLA.0b013e318195e12f
Original Articles
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Content: Older adults frequently undergo abdominopelvic surgical operations, yet the risk and significance of postoperative discharge disposition has not been well characterized.

Objective: To describe the population-level risk of discharge to institutional care facilities and its impact on survival among older patients who undergo common abdominopelvic surgical procedures.

Design, Setting, and Participants: A retrospective, population-based cohort study, using the Washington State hospital discharge database for 89,405 adults aged 65 and older who underwent common abdominopelvic procedures (cholecystectomy, colectomy, hysterectomy/oophorectomy, and prostatectomy) between 1987 and 2004.

Main Outcome Measures: Discharge location and short-term and long-term mortality.

Results: Advancing age was associated with discharge to an institutional care facility (ICF) after surgery [age, 65–69 (3.3%); 70–74 (5.7%); 75–79 (10.8%); 80–84 (20.6%); 85–89 (31.8%); 90+ (43.9%); trend test, P < 0.001). Postoperative complications were also associated with discharge to an ICF (21.9% vs. 8.9%, P < 0.001). Patients discharged to an ICF after surgery had higher 30-day (4.3% vs. 0.4%), 90 day (12.6% vs. 1.4%), and 1-year mortality (22.2% vs. 5.9%) in comparison with those discharged home with self-care (P < 0.001). Compared with similarly aged adults discharged home, patients discharged to an ICF had 4 times higher 1-year mortality (odds ratio = 3.9; 95% confidence interval = 3.6–4.2). Of patients who died after discharge to an ICF, the majority died either at the ICF (53.7%) or on a subsequent hospital admission (31.0%).

Conclusions: Advancing age and postoperative complications are associated with the risk of discharge to an ICF after abdominopelvic operations. Patients discharged to an ICF are much more likely to die within the first postoperative year and ICF disposition should be considered as either a marker of debility and/or a component of patient decline. These findings may be helpful while counseling patients regarding the expected outcomes of ICF placement after surgical intervention.

This study describes the population-level risk of discharge to institutional care facilities and its impact on survival among older patients undergoing common abdominopelvic surgical procedures. Patients who required skilled care after abdominal and or pelvic surgery had much higher mortality rates than expected, with 1 in 5 patients discharged to an institutional care facility dying within the first year after surgery.

From the *Department of Medicine, Division of Gerontology and Geriatric Medicine, University of Washington School of Medicine, Seattle, Washington; and †Department of Surgery, Surgical Outcomes Research Center, University of Washington School of Medicine, Seattle, Washington.

Supported by the NIH Roadmap Multidisciplinary Clinical Research Career Development Award Grant (8K12RR023265-02) from the National Institutes of Health and the Hartford/American Federation for Aging Research.

Reprints: Nader N. Massarweh, MD, Department of Surgery, University of Washington, 1959 NE Pacific St, Box 356410, Seattle, WA 98195-6410. E-mail: massar@u.washington.edu.

© 2009 Lippincott Williams & Wilkins, Inc.