Effect of Posthospital Syndrome on Health Care Utilization After Abdominal Contouring Surgery

Abstract

Background: Post-hospital syndrome (PHS) is a transient condition after acute hospitalizations when patients are physiologically deconditioned. The objective of this study was to determine if having PHS at the time of abdominal contouring surgery increased the incidence of post-operative adverse medical events. Methods: We conducted a retrospective cohort study of patients enrolled in the MarketScan Databases who underwent outpatient functional or cosmetic abdominal contouring surgery (i.e. abdominoplasty, liposuction, or panniculectomy) from April 2010 to August 2015. Patients were separated into two groups based upon PHS exposure, defined by hospitalization within 90 days prior to surgery. Differential healthcare utilization within 30 days after surgery was compared between cohorts. Results: Among the 18,947 patients included in the final cohort, 1,045 patients (6%) had PHS at the time of abdominal contouring surgery. Patients with PHS experienced more emergency department visits (0.16 vs. 0.08 visits, adjusted odds ratio =1.60, p<0.001) and more episodes of hospitalization (0.11 vs. 0.04 episodes, AOR=1.70, p<0.001) within 30 days postoperatively. The mean unadjusted healthcare utilization following abdominal contouring surgery for patients with PHS was $7,888 (SD=17,659) versus $2,943 (SD=9,096) in patients without PHS. After controlling for confounders, such as comorbidity-burden, PHS was associated with $3,944 greater cost than patients without PHS (p<0.001). Conclusion: Among patients undergoing outpatient abdominal contouring surgery, having PHS increased the incidence of adverse medical events requiring medical attention in the 30-day post-operative period. These findings support the inclusion of PHS in pre-operative evaluation and preparation for patients seeking abdominal contouring surgery.

Actigraphy to Evaluate Changes in Physical Activity After Autologous Breast Reconstruction

“…This is attributed to many factors related to surgery, including pain, acute blood loss anemia, and the inflammatory phase of healing. Furthermore, it is well established that patients experience physical deconditioning from the impact of being hospitalized 18,19 . This is related to several factors including poly-pharmacy (notably narcotics), disturbance in sleep-wake cycle, malnutrition, and the psychosocial stress of being hospitalized.…”

“…Furthermore, it is well established that patients experience physical deconditioning from the impact of being hospitalized. 18,19 This is related to several factors including poly-pharmacy (notably narcotics), disturbance in sleep-wake cycle, malnutrition, and the psychosocial stress of being hospitalized. Studies have found that patients are transiently vulnerable in the posthospitalization period and are at an increased risk of complications and increased health care utilization (eg, emergency department visits).…”