The population is aging and more geriatric patients are undergoing surgery. The national burden and age-specific outcomes of previously defined high-risk colorectal procedures (HRCP) remain unknown. Using the 2014 National Inpatient Sample, patients were stratified into nongeriatric (NG, <65 years), younger geriatric (YG, 65–79 years), and older geriatric (OG, ≥80 years) cohorts. Cases were grouped into nonelective admissions (NA) and elective admissions (EA). Nationally representative outcomes were compared across age group and admission type. Of 215,425 patients undergoing HRCP, 47.3 per cent were ≥65 years. During NA and EA, inpatient mortality, discharge to nursing facility, and median postoperative length of stay increased with each increasing age category (P < 0.001). Outcomes during NA were worse than EA in all age groups (P < 0.001). For example, rates of discharge to nursing facility were 13.4 per cent NG, 39.4 per cent YG, and 64.7 per cent OG during; NA and 3.1 per cent NG, 13.3 per cent YG, and 34 per cent OG during EA. During NA and EA, cost was equal in YG and OG but greater than in NG. Outcomes after HRCP are worse for older patients and for nonelective cases. This information can inform preoperative counseling and targeted quality improvement projects. Further work is needed to understand geriatric-specific risk factors and outcomes to provide high-quality patient-centered care.
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References
1.
TurrentineF.E., WangH., SimpsonV.B.Surgical risk factors, morbidity, and mortality in elderly patients.J Am Coll Surg2006; 203: 865–77.
2.
FriedT.R., BradleyE.H., TowleV.R.Understanding the treatment preferences of seriously ill patients.N Engl J Med2002; 346: 1061–6.
3.
SchwarzeM.L., BarnatoA.E., RathouzP.J.Development of a list of high-risk operations for patients 65 years and older.JAMA Surg2015; 150: 325–31.
4.
HCUP National Inpatient Sample (NIS).Healthcare Cost and Utilization Project (HCUP).2014. Agency for Healthcare Research and Quality, Rockville, MD. Available at: www.hcup-us.ahrq.gov/nisoverview.jsp. Accessed November 26, 2017.
5.
All Patient Refined Diagnosis Related Groups (APR-DRGs) Methodology Overview.Wallingford, CT: 3M Health Information Systems, 1998.
6.
HCUP Cost-to-Charge Ratio Files (CCR).Healthcare Cost and Utilization Project (HCUP).2014. Agency for Healthcare Research and QualityRockville, MD. Available at: www.hcup-us.ahrq.gov/db/state/costtocharge.jsp. Accessed November 26, 2017.
7.
CohenM.E., BilimoriaK.Y., KoC.Y.Development of an American College of surgeons national surgery quality improvement program: morbidity and mortality risk calculator for colorectal surgery.J Am Coll Surg2009; 208: 1009–16.
8.
BilimoriaK.Y., LiuY., ParuchJ.L.Development and evaluation of the universal ACS NSQIP surgical risk calculator: a decision aide and informed consent tool for patients and surgeons.J Am Coll Surg2013; 217: 833–42.
9.
BerianJ.R., ParuchJ.L., CohenM.E.Does performance vary within the same hospital when separately examining different patient subgroups?J Am Coll Surg2016; 222: 790–79.
