Impact of Post-Hospital Syndrome on Outcomes Following Elective, Ambulatory Surgery

Brownlee, Sarah A.; Blackwell, Robert H.; Blanco, Barbara A.; Zapf, Matthew; Kliethermes, Stephanie; Gupta, Gopal N.; Kuo, Paul C.; Kothari, Anai N.

doi:10.1097/sla.0000000000001965

Cited by 24 publications

(18 citation statements)

References 18 publications

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“…PHS is characterized by the risk of early re-hospitalization due to physiologic stressors resulting from the initial admission, including disruption in sleep-wake cycles, inadequate pain control, deconditioning, and changes in nutritional status. Patients hospitalized within 90 days of elective surgery are at increased risk of PHS [181].…”

Section: Hospital Discharge and Continuity Of Carementioning

confidence: 99%

Perioperative Management of Elderly patients (PriME): recommendations from an Italian intersociety consensus

et al. 2020

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Background Surgical outcomes in geriatric patients may be complicated by factors such as multiple comorbidities, low functional performance, frailty, reduced homeostatic capacity, and cognitive impairment. An integrated multidisciplinary approach to management is, therefore, essential in this population, but at present, the use of such an approach is uncommon. The Perioperative Management of Elderly patients (PriME) project has been established to address this issue. Aims To develop evidence-based recommendations for the integrated care of geriatric surgical patients. Methods A 14-member Expert Task Force of surgeons, anesthetists, and geriatricians was established to develop evidence-based recommendations for the pre-, intra-, and postoperative care of hospitalized older patients (≥ 65 years) undergoing elective surgery. A modified Delphi approach was used to achieve consensus, and the strength of recommendations and quality of evidence was rated using the U.S. Preventative Services Task Force criteria. Results A total of 81 recommendations were proposed, covering preoperative evaluation and care (30 items), intraoperative management (19 items), and postoperative care and discharge (32 items). Conclusions These recommendations should facilitate the multidisciplinary management of older surgical patients, integrating the expertise of the surgeon, the anesthetist, the geriatrician, and other specialists and health care professionals (where available) as needed. These roles may vary according to the phase and setting of care and the patient’s conditions.

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Section: Hospital Discharge and Continuity Of Carementioning

confidence: 99%

Perioperative Management of Elderly patients (PriME): recommendations from an Italian intersociety consensus

et al. 2020

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“…Our results draw attention to the significance of post-hospital syndrome, defined by Krumholz as a transient period of increased medical vulnerability after a hospital discharge 14 . Although the timeframe has not been defined, previous work studying outcomes of outpatient hernia repairs found that the 30-day risk of adverse events was significantly higher in patients hospitalized within 90 days leading up to surgery 15 . van Walraven et al 16 introduced the LACE index (Length of stay, Acuity of admission, Charlson comorbidity score, Emergency department use), a quantifiable assessment of risk of death or unplanned 30-day readmission after hospitalization; ED visits in the 180 days before admission are included in the score.…”

Section: Discussionmentioning

confidence: 73%

Thirty-day hospital revisits after prostate brachytherapy: who is at risk?

Kirshenbaum

Blackwell

et al. 2019

Prostate International

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Background Transperineal prostate brachytherapy is a common outpatient procedure for the treatment of prostate cancer. Whereas long-term morbidity and toxicities are widely published, rates of short-term complications leading to hospital revisits have not been well described. Materials and methods Patients who underwent brachytherapy for prostate cancer in an ambulatory setting were identified in the Healthcare Cost and Utilization Project State Ambulatory Surgery Database for California between 2007 and 2011. Emergency department (ED) visits and inpatient admissions within 30 days of treatment were determined from the California Healthcare Cost and Utilization Project State Emergency Department Database and State Inpatient Database, respectively. Results Between 2007 and 2011, 9,042 patients underwent brachytherapy for prostate cancer. Within 30 days postoperatively, 543 (6.0%) patients experienced 674 hospital encounters. ED visits comprised most encounters (68.7%) at a median of 7 days (interquartile range 2–16) after surgery. Inpatient hospitalizations occurred on 155 of 674 visits (23.0%) at a median of 12 days (interquartile range 5–20). Common presenting diagnoses included urinary retention, malfunctioning catheter, hematuria, and urinary tract infection. Logistic regression demonstrated advanced age {65–75 years: odds ratio [OR], 1.3 [95% confidence interval (CI) 1.06–1.60, P = 0.01]; >75 years: OR 1.5 [95% CI 1.18–1.97, P = 0.001]}, inpatient admission within 90 days before surgery [OR 2.68 (95% CI 1.8–4.0, P < 0.001)], and ED visit within 180 days before surgery [OR 1.63 (95% CI 1.4–1.89, P < 0.001)] as factors that increased the risk of hospital-based evaluation after outpatient brachytherapy. Charlson comorbidity score did not influence risk. Conclusions ED visits and inpatient admissions are not uncommon after prostate brachytherapy. Risk of revisit is higher in elderly patients and those who have had recent inpatient or ED encounters.

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“…15,16 Previous research suggests that recently discharged patients frequently develop new health problems or experience a post-hospitalization syndrome characterized by deconditioning and residual symptoms, which may lead to readmission. 6,15,16,[18][19][20]25 Furthermore, difficulties with independent daily living represent a major contributing factor to readmission. 26 Therefore, improvement in general health status, as well as treatment of the acute illness that caused IH, should both be targets of post-discharge care.…”

Section: Discussionmentioning

confidence: 99%

“…[3][4][5][6][11][12][13][14] However, unplanned 30-day readmissions are not always due to suboptimal IH care: recently discharged patients are frequently readmitted for a wide range of health conditions unrelated to the IH. 7,[15][16][17][18][19][20] Therefore, current post-discharge interventions primarily focusing on the acute illness treated during IH may be insufficient. 15,16 Indeed, literature suggests that, among patients whose primary diagnosis during IH placed them in the Centers for Medicare and Medicaid Services' (CMS) initial Hospital Readmission Reduction Program (HRRP), only 10.0-35.2% of readmissions were attributable to the same conditions as IH.…”

Section: Introductionmentioning

confidence: 99%

Post-Discharge Services for Different Diagnoses Than Index Hospitalization Predict Decreased 30-Day Readmissions Among Medicare Beneficiaries

et al. 2019

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BACKGROUND: Efforts to reduce hospital readmissions include post-discharge interventions related to the illness treated during the index hospitalization (IH). These efforts may be inadequate because readmissions are precipitated by a wide range of health conditions unrelated to the primary diagnosis of the IH. OBJECTIVE: To investigate the relationship between post-discharge health services utilization for the same or a different diagnosis than the IH and unplanned 30-day readmission. DESIGN AND PARTICIPANTS: The study sample included 583,199 all-cause IHs among 2014 Medicare fee-forservice beneficiaries. For all-cause IH, as well as individually for heart failure, myocardial infarction, and pneumonia IH, we used multivariable logistic regressions to investigate the association between post-discharge services utilization and readmission. MAIN MEASURES: The outcome was unplanned 30-day readmission. Primary independent variables were postdischarge services utilization, including institutional outpatient, office-based primary care, office-based specialist, office-based non-physician practitioner, emergency department, home health care, and skilled nursing facility providers. KEY RESULTS: Among all-cause IH, 11.7% resulted in unplanned 30-day readmissions, and only 18.1% of readmissions occurred for the same primary diagnosis as IH. A substantial majority of post-discharge health services were utilized for a primary diagnosis differing from IH. Compared with no visit, institutional outpatient visits for the same primary diagnosis as IH (odds ratio [OR], 0.33; 95% confidence interval [CI], 0.31-0.34) and for a different primary diagnosis than IH (OR, 0.36; 95% CI, 0.35-0.37) were similarly strongly associated with decreased unplanned 30-day readmission. Primary care physician, specialist, non-physician practitioner, and home health care showed similar patterns. IH for heart failure, myocardial infarction, and pneumonia manifested similar patterns to all-cause IH both in terms of postdischarge services utilization and in terms of its impact on readmission. CONCLUSIONS: To reduce unplanned 30-day readmission more effectively, discharge planning should include post-discharge services to address health conditions beyond the primary cause of the IH.

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Impact of Post-Hospital Syndrome on Outcomes Following Elective, Ambulatory Surgery

Cited by 24 publications

References 18 publications

Perioperative Management of Elderly patients (PriME): recommendations from an Italian intersociety consensus

Perioperative Management of Elderly patients (PriME): recommendations from an Italian intersociety consensus

Thirty-day hospital revisits after prostate brachytherapy: who is at risk?

Post-Discharge Services for Different Diagnoses Than Index Hospitalization Predict Decreased 30-Day Readmissions Among Medicare Beneficiaries

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