Octogenarians unable to return home by postoperative-day 30

Xane D Peters; Lindsey M Zhang; Yaoming Liu; Mark E Cohen; Ronnie A Rosenthal; Clifford Y Ko; Marcia M Russell

doi:10.1016/j.amjsurg.2024.115926

Octogenarians unable to return home by postoperative-day 30

Am J Surg. 2024 Dec:238:115926. doi: 10.1016/j.amjsurg.2024.115926. Epub 2024 Aug 23.

Authors

Xane D Peters¹, Lindsey M Zhang², Yaoming Liu³, Mark E Cohen³, Ronnie A Rosenthal⁴, Clifford Y Ko⁵, Marcia M Russell⁶

Affiliations

¹ American College of Surgeons, Division of Research and Optimal Patient Care, Chicago, IL, USA; Loyola University Medical Center, Department of Surgery, Maywood, IL, USA. Electronic address: [email protected].
² American College of Surgeons, Division of Research and Optimal Patient Care, Chicago, IL, USA; University of Chicago Medical Center, Department of Surgery, Chicago, IL, USA; Washington University School of Medicine, Department of Surgery, St. Louis, MO, USA.
³ American College of Surgeons, Division of Research and Optimal Patient Care, Chicago, IL, USA.
⁴ Yale University, Department of Surgery, New Haven, CT, USA; Veteran Affairs Connecticut Healthcare System, West Haven, CT, USA.
⁵ American College of Surgeons, Division of Research and Optimal Patient Care, Chicago, IL, USA; David Geffen School of Medicine at the University of California Los Angeles, Department of Surgery, Los Angeles, CA, USA; VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.
⁶ David Geffen School of Medicine at the University of California Los Angeles, Department of Surgery, Los Angeles, CA, USA; VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.

PMID: 39303481
DOI: 10.1016/j.amjsurg.2024.115926

Abstract

Background: For older adults undergoing surgery, returning home is instrumental for functional independence. We quantified octogenarians unable to return home by POD-30, assessed geriatric factors in a predictive model, and identified risk factors to inform decision-making and quality improvement.

Methods: This retrospective cohort study examined patients ≥80 years old from the ACS NSQIP Geriatric Surgery Pilot, using sequential logistic regression modelling. The primary outcome was non-home living location at POD-30.

Results: Of 4946 patients, 19.8 % lived in non-home facilities at POD-30. Increased odds of non-home living location were seen in patients with preoperative fall history (OR 2.92, 95%CI 2.06-4.14) and new postoperative pressure ulcer (OR 2.66, 95%CI 1.50-4.71) Other significant geriatric-specific risk factors included mobility aid use, surrogate-signed consent, and postoperative delirium, with odds ratios ranging from 1.42 (1.19-1.68) to 1.97 (1.53-2.53).

Conclusions: These geriatric-specific risk factors highlight the importance of preoperative vulnerability screening and intervention to inform surgical decision-making.

Keywords: Geriatric surgery; Living location; Non-home discharge; Octogenarian; Surgical quality.

MeSH terms

Aged, 80 and over
Female
Geriatric Assessment
Humans
Male
Patient Discharge / statistics & numerical data
Postoperative Complications* / epidemiology
Retrospective Studies
Risk Factors