Skilled care utilization after abdominal and pelvic cancer surgery in older patients

Abstract

Background and objectivesOlder cancer patients are less likely to return home after surgery. Utilization of post acute skilled services in this setting is associated with increased mortality. Medicare payments for post acute care continue to grow. This study aims to identify factors associated with the utilization of post acute services at hospital discharge after abdominopelvic cancer surgery. MethodsThis is a retrospective analysis of older cancer patients (age>75) who presented to the Geriatrics clinic at Memorial Sloan Kettering Cancer Center for preoperative evaluation between October 2010 and December 2012. Sociodemographic features, pre-operative geriatric assessment, hospitalization characteristics and discharge disposition data were collected and analyzed. ResultsOut of 592 patients (age>75), 291 (49.2%) were discharged home without services and 301 (50.8%) were discharged home with skilled services or to a skilled nursing facility. Older age (OR 1.058, P=0.010), preoperative ADL dependency (OR 2.242, P=0.001), longer operation time (OR 1.004, P<0.001) and postoperative delirium (OR 2.213, P=0.004) were independently associated with skilled care utilization. ConclusionsOptimizing preoperative status, implementing delirium prevention protocols and streamlining the hospital stay may impact the discharge disposition, helping control healthcare costs and achieving a better outcome for the older surgical cancer patient.