Not all is lost: Functional recovery in older adults following emergency general surgery

Abstract

BACKGROUND:Although functional decline and death are common long-term outcomes among older adults following emergency general surgery (EGS), we hypothesized that patients' postdischarge function may wax and wane over time. Periods of fluctuation in function may represent opportunities to intervene to prevent further decline. Our objective was to describe the functional trajectories of older adults following EGS admission. METHODS:This was a population-based retrospective cohort study of all independent, community-dwelling older adults (age ≥65 years) in Ontario with an EGS admission (2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016). A multistate model was used to examine patients' functional trajectories over the 5 years following discharge. Patients were followed as they transitioned back and forth between functional independence, use of chronic home care (in-home assistance for personal care, homemaking, or medical care for at least 90 days), nursing home admission, and death. RESULTS:We identified 78,820 older adults with an EGS admission (mean age, 77 years; 53% female). In the 5 years following admission, 32% (n = 24,928) required new chronic home care, 21% (n = 5,249) of whom had two or more episodes of chronic home care separated by periods of independence. The average time spent in chronic home care was 11 months, and 50% (n = 12,679) of chronic home care episodes ended with a return to independence. For patients requiring chronic home care at any time, the probability of returning to independent living during the subsequent 5 years ranged from 36% to 43% annually. CONCLUSION:Not all is lost for older adults who experience functional decline following EGS admission. Half of those who require chronic home care will recover to independence, and one-third will have a durable recovery, remaining independent after 5 years. Fluctuations in function in the years following EGS may represent a unique opportunity for interventions to promote rehabilitation and recovery among older adults.

Not all is lost: Dynamic functional recovery in older adults following emergency general surgery

“…Studies that have looked at postdischarge outcomes for older EGS patients have primarily focused on patients with high illness burden or frailty, finding that these patients have high health care utilization and mortality in the year following discharge. 3,4 Guttman et al 5 add to the literature by focusing on functionally independent older adults who present with an EGS diagnosis managed both operatively and nonoperatively and, in doing so, provide new insight into the postdischarge trajectory of a large proportion of EGS patients. Exemplary features of this study include the data source, made possible by the governmentfunded health care system of the province of Ontario and the Institute for Clinical Evaluative Sciences research institute.…”