Key result
Preoperative risk factors including age >85 years, BMI >30, functional dependence, and living alone were associated with a higher risk of nonhome discharge following elective surgery.
Why the study?
The study was conducted to identify preoperative patient risk factors for nonhome discharge in home-dwelling older patients undergoing elective surgery.
What are the preoperative risk factors that predict nonhome discharge in home-dwelling geriatric patients undergoing elective surgery?
Cohort
Yes
What are the preoperative risk factors that predict nonhome discharge in home-dwelling geriatric patients undergoing elective surgery?
Identifying preoperative risk factors for nonhome discharge in geriatric patients can help guide preoperative counseling and optimization.
May inform preoperative counseling on discharge risk; leaves open whether modifying factors improves home discharge rates.
To identify patient risk factors for nonhome discharge (NHD) for home-dwelling older patients undergoing surgery, we performed a retrospective cohort study of patients aged ≥65 years undergoing elective surgery between 2014 and 2016 using the geriatric research file from the National Surgical Quality Improvement Program (NSQIP). Multivariable logistic regression examined the association between preoperative demographics, comorbidities, and functional status and NHD to determine which factors are most strongly predictive of NHD. Risk of NHD was higher among those of age >85 years, age 75 to 85 years, Black race, with body mass index (BMI) >30, dyspnea with exertion or at rest, partially or totally dependent in activities of daily living (ADLs), preoperative steroid use, preoperative wound infection, use of a mobility aid, fall within 3 months, or living alone at home without support. NHDs were statistically more likely among orthopedic, neurosurgery, or cardiac surgery interventions. Understanding individual patient's risks and setting expectations for likely postoperative course is integral to appropriate preoperative counseling and preoperative optimization.
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Warwick et al. (2020) conducted a cohort in Home-dwelling older patients undergoing elective surgery. Preoperative risk factors (advanced age, high BMI, functional dependence, comorbidities) vs. Patients without these risk factors was evaluated on Nonhome discharge (NHD). Preoperative risk factors including age >85 years, BMI >30, functional dependence, and living alone were associated with a higher risk of nonhome discharge following elective surgery.
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