Incidence and Outcomes of Unplanned Intensive Interventions After Common Inpatient Surgeries: A Population-Based Cohort Study

Objective: To determine the incidence, predictors, and outcomes of unplanned intensive interventions after common inpatient surgeries among older adults. Background: Intensive interventions in older adults may profoundly affect prognosis and recovery after surgery, yet their frequency and association with outcomes such as mortality are unknown. Methods: We conducted a retrospective cohort study using Medicare fee-for-service claims (2016–2020), including patients aged ≥66 years who underwent 1 of the 10 most common inpatient surgeries. Unplanned intensive interventions—cardiopulmonary resuscitation, prolonged mechanical ventilation, tracheostomy, new dialysis, extracorporeal membrane oxygenation, or feeding tube placement—were identified during the index hospitalization. Multivariable generalized estimating equation models identified predictors, and propensity score-weighted models assessed 1-year outcomes. Results: Among 1,095,445 surgeries, intensive interventions occurred in 20,669 (1.9%) patients, most commonly cardiopulmonary resuscitation (67.6%) and prolonged ventilation (22.3%). Frailty was the strongest predictor [adjusted odds ratio (aOR) 1.67, 95% confidence interval (CI) 1.60–1.73], followed by urgent/emergent surgery (aOR 1.18, 95% CI 1.13–1.23), older age, male sex, and higher comorbidity burden. Patients experiencing intensive interventions had markedly worse outcomes: inpatient mortality 24.6% versus 0.5% (aOR 51.4, 95% CI 47.1–56.1), 1-year mortality 44.2% versus 5.2% (aOR 11.6, 95% CI 10.8–12.4), and 90-day nursing home admission 8.9% versus 1.8% (aOR 5.0, 95% CI 4.2–5.9). Conclusions: Although uncommon, unplanned intensive interventions after common surgeries are associated with dramatically higher mortality and institutionalization. Frailty, comorbidity, older age, male sex, and urgent/emergent surgery identify patients at greatest risk. These findings support incorporating intensive intervention risk into preoperative discussions and postintervention care planning to promote goal-concordant decisions.