Preoperative impairment is associated with a higher postdischarge level of care

Colin C. Ehlenbach, Sarah E. Tevis, Gregory D. Kennedy, Sarah C. Oltmann

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Background: Although preoperative risk factors have been shown to lead to postdischarge institutionalization, an association between preoperative risk factors, preoperative level of required care, and discharge to higher levels of care has not previously been demonstrated. Materials and methods: Using an institutional American College of Surgeons National Surgical Quality Improvement Program database, a retrospective review of elderly patients undergoing nonemergent inpatient general surgery procedures was performed with the goal of identifying preoperative risk factors that indicated the need for a higher level of care on hospital discharge. Univariate and multivariate analyses were performed on the patient population. Results: Over a 4-y period, 585 patients (29%) within the database were aged ≥65 y. In this population, 12% of patients required discharge to a higher level of care compared with their preoperative origin. In patients aged ≥65 y, impaired cognition, decreased functional capacity, advanced age (≥79 y), high American Society of Anesthesiologists class, and long hospital length of stay were found in univariate analysis to be associated with postoperative discharge to a higher level of care, although all of these variables except decreased functional capacity were also associated with a higher discharge level of care in multivariate analysis. Conclusions: Cognitive and functional capacity scoring can be used as simple ways to indicate discharge to a higher level of care for older adults. Preoperative counseling in highrisk older adults needs to include the likelihood for discharge to a higher level of care, so that a possible referral to social work can be placed during discharge planning.

Original languageEnglish (US)
Pages (from-to)1-6
Number of pages6
JournalJournal of Surgical Research
Volume193
Issue number1
DOIs
StatePublished - 2015

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Patient Discharge
Length of Stay
Multivariate Analysis
Databases
Institutionalization
Quality Improvement
Social Work
Cognition
Population
Counseling
Inpatients
Referral and Consultation

Keywords

  • Cognitive function
  • Discharge destination
  • Multidisciplinary team
  • Preoperative geriatric assessment
  • Surgical outcomes

ASJC Scopus subject areas

  • Surgery
  • Medicine(all)

Cite this

Preoperative impairment is associated with a higher postdischarge level of care. / Ehlenbach, Colin C.; Tevis, Sarah E.; Kennedy, Gregory D.; Oltmann, Sarah C.

In: Journal of Surgical Research, Vol. 193, No. 1, 2015, p. 1-6.

Research output: Contribution to journalArticle

Ehlenbach, Colin C. ; Tevis, Sarah E. ; Kennedy, Gregory D. ; Oltmann, Sarah C. / Preoperative impairment is associated with a higher postdischarge level of care. In: Journal of Surgical Research. 2015 ; Vol. 193, No. 1. pp. 1-6.
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