Discharge to an institutional care facility after abdominopelvic surgery was associated with significantly higher 1-year mortality compared to discharge home (22.2% vs 5.9%; OR 3.9, 95% CI 3.6-4.2).
Cohort (n=89,405)
Yes
Does discharge to an institutional care facility after abdominopelvic surgery impact mortality in older adults?
Discharge to an institutional care facility after abdominopelvic surgery in older adults is associated with significantly higher 1-year mortality, serving as a marker of debility or patient decline.
Odds Ratio: 3.9 (95% CI 3.6–4.2)
Absolute Event Rate: 22.2% vs 5.9%
p-value: p=<0.001
In Brief 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.
Legner et al. (2009) conducted a cohort in Older adults undergoing common abdominopelvic surgical procedures (n=89,405). Discharge to an institutional care facility (ICF) vs. Discharge home with self-care was evaluated on 1-year mortality (OR 3.9, 95% CI 3.6-4.2, p=<0.001). Discharge to an institutional care facility after abdominopelvic surgery was associated with significantly higher 1-year mortality compared to discharge home (22.2% vs 5.9%; OR 3.9, 95% CI 3.6-4.2).