Abstract
More than half of all surgical patients are age 65 and older, and research suggests that a majority of these patients will require postacute-care (PAC) rehabilitation services. Despite the growing costs, characteristics related to requiring PAC in the elderly abdominal surgery population are not well studied. This project aims to describe discharge trends, as well as factors related to requiring placement at a skilled-nursing facility in the elderly abdominal surgery population.
Primary Author and Speaker: Erika Dobson
Contributing Authors: Rebecca Julian, Hailey Zanette
Health care associated costs of elderly patients are 3 to 5 times higher than costs for younger patients, and the elderly face unique challenges when recovering from major surgery (Alexander, Shahrokni, Mahmoudzadeh Pournaki, & Korc-Grodzicki, 2016). However, more than one-half of all operations performed in the United States involve patients older than 65 years of age (Robinson et al., 2011). Studies have estimated that 45% of those older than 65 years will have ongoing care needs after hospital discharge, and will require post-acute care (PAC) rehabilitation services, including inpatient and home therapy, with the large majority of these patients discharging to a skilled nursing facility (SNF) (Balentine et al., 2016). Despite the large healthcare cost associated with the elderly surgical population, little research has been done to identify characteristics related to requiring PAC at discharge, specifically discharge to a SNF. The aim of this project was to (i) describe discharge trends in adults age 65+ undergoing abdominal surgery at a large urban hospital and to (ii) identify factors related to requiring placement at a skilled nursing facility (SNF) upon discharge. This project included 64 adults over 65 years of age at a large urban hospital, admitted to the abdominal surgery service. All participants had either an occupational therapy (OT) and/or physical therapy (PT) consultation. Of the 65 included, 55 had both OT and PT consults, 9 had solely PT consults, and 0 had solely OT consults. Of the 55 OT consults, 48 were functionally evaluated. The median age of inclusion was 74.91 years of age (ranging from 65-95 years). Participants undergoing conservative management were not included in this project. Participants were evaluated using the Boston University Activity Measure for Post Acute Care (AMPAC), with the ADL portion being scored by an occupational therapist, and the Mobility portion being scored by one of two physical therapists. Scores were assigned after each treatment, and results of this project were determined using the ADL and Mobility score at discharge. Average time from admission to consultation was 3.81 days for PT, with participants receiving and average of 2.76 treatments, and 4.50 days for OT, with participants receiving an average of 1.67 treatments. Of all participants included, 15.62% discharged home without services (10/64), 39.01% discharged home with services (25/64), 37.50% discharged to a SNF (24/64), and 7.81% discharged to an acute rehabilitation facility (5/64). Those participants aged 76 years and older were more likely to require another level of care at discharge (p = 0.01) as compared to the 65-75 group, however length of stay did not statistically differ between groups (p = 0.39). Statistically significant differences were observed in AMPAC-ADL scores between those age 65-75 and those 76+ (p = 0.04), while differences in AMPAC-Mobility scores were approaching significance (p = 0.08). Using case-wise deletion, unpaired t tests were calculated for those participants evaluated by OT (n = 48), to determine factors related to discharging to a SNF. Factors included AMPAC-ADL score (p < 0.0001) and AMPAC-Mobility score (p = 0.0026). Number of OT treatments was not statistically related to SNF placement (p = 0.21). Over half of elderly adults undergoing abdominal surgery at a large urban hospital require PAC, with over one third discharging to a SNF. Age and independence with ADLs were strongly linked to requiring PAC, and scores on AMPAC-ADL and AMPAC-Mobility were statistically related to placement at a SNF post discharge. This study highlights the importance of ADL independence as a modifiable factor in reducing the need for PAC, specifically SNF placement, in the elderly surgical population.
Alexander, K., Shahrokni, A., Mahmoudzadeh Pournaki, S., & Korc-Grodzicki, B. (2016). Skilled care utilization after abdominal and pelvic cancer surgery in older patients https://doi.org///doi.org/10.1016/j.eurger.2016.06.007
Robinson, T. N., Wallace, J. I., Wu, D. S., Wiktor, A., Pointer, L. F., Pfister, S. M., . . . Moss, M. (2011). Accumulated frailty characteristics predict postoperative discharge institutionalization in the geriatric patient https://doi.org/10.1016/j.jamcollsurg.2011.01.056
Balentine, C. J., Naik, A. D., Berger, D. H., Chen, H., Anaya, D. A., & Kennedy, G. D. (2016). Postacute care after major abdominal surgery in elderly patients: Intersection of age, functional status, and postoperative complications. JAMA Surgery, 151(8), 759-766. https://doi.org/10.1001/jamasurg.2016.0717 [doi]