The Significance of Discharge to Skilled Care After Abdominopelvic Surgery in Older Adults

Abstract

Advancing age and postoperative complications are associated with the risk of discharge to an ICF after abdominopelvic operations. Patients discharged to an ICF are much more likely to die within the first postoperative year and ICF disposition should be considered as either a marker of debility and/or a component of patient decline. These findings may be helpful while counseling patients regarding the expected outcomes of ICF placement after surgical intervention.

Laparoscopic colectomy is safe and leads to a significantly shorter hospital stay for octogenarians

“…The data from our study suggest that LC still is feasible for octogenarians despite the higher associated surgical risk. Although a recent study showed that advancing age and postoperative complications are associated with the risk of discharge to a nursing facility after abdominopelvic operations [25], most patients in our series who underwent LC were discharged home with or without assistance, and this was comparable with the OC results.…”

Which Patients Require More Care after Hospital Discharge? An Analysis of Post-Acute Care Use among Elderly Patients Undergoing Elective Surgery

“…Over the past 2 decades, while hospital length of stay has decreased, there has been a corresponding and substantial increase in the use of post-acute care (PAC), including skilled nursing facilities (SNF), inpatient rehabilitation facilities (IRF), and home health care (HHC). [1][2][3] Nearly half of hospitalized Medicare patients use PAC after discharge, accounting for more than $62 billion in 2012 expenditures. 4,5 As a result, the Centers for Medicare and Medicaid Services (CMS) is developing payment policies aimed at reducing costs and ensuring appropriate use of PAC.…”

Hospitalization Trends After Prostate and Bladder Surgery: Implications of Potential Payment Reforms

“…In the surgical literature, patients recovering from abdominopelvic surgery have 4 times higher 1-year mortality rates if they are discharged to an institutional care facility rather than home with self-care. 9 Moreover, those discharged home with supplemental care fare better than those discharged to a facility, yet still experience higher 1-year mortality rates than those discharged home without services. 9 These findings mirror those for cystectomy cases as well, in that 90-day mortality rates are higher for those discharged to subacute care facilities than for those discharged home with or without additional care.…”

“…7 From a quality of care perspective, implications of the increased use of ancillary care are under-investigated, although some evidence suggests that patients discharged to skilled nursing facilities have higher mortality rates. 8,9 Within urology, how reduced inpatient stays influence short-term outcomes such as readmissions and post-acute care remains underappreciated. Furthermore, these effects may vary depending on the complexity of the procedure.…”