Discharge to Postacute Care as a Benchmarking Metric for Elderly Surgical Patients

BACKGROUND: Discharge to post-acute care can be an unanticipated and costly surgical outcome. We examined whether discharge to post-acute care can be used as a benchmarking metric in care for older adults. STUDY DESIGN: Data from non-DoD (Department of Defense) US hospitals participating in ACS NSQIP between January 1st and December 31st 2023 were eligible for inclusion. Patients were included if they were aged 65 or older and admitted from "home/permanent" residence prior to their primary operation. Hierarchical random effects logistic regression with empirical Bayes smoothing were used for risk-adjusted benchmarking. The event of interest was discharge to "Other Facility" after risk adjustment for appropriate variables. RESULTS: A total of 494 hospitals were included (277,160 patients, 30,907 (11.2%) of which were discharged to post-acute care). Approximately one fourth of hospitals (22.5%) received an "Exemplary" rating and 25.5% received a "Needs Improvement" rating. Similar results were seen when only the 25% of highest risk patients were evaluated, after exclusion of patients with prior major morbidity, and when international and DoD hospitals were included. Risk factors included ASA IV/IV (OR 2.50, 95% CI 1.70-3.70) and inpatient surgery (OR 6.20, 95% CI 5.90-6.50). CONCLUSION: Discharge to post-acute care can be used as a benchmarking metric for hospitals in older adult surgical patients. Findings are consistent across subsets of data based on preexisting major morbidity and high-risk status. Benchmarked results can help hospitals identify discharge to post-acute care as a target for quality improvement. Further research is needed to better understand hospital factors that may affect outlier status.