Which Geriatric Variables Most Strongly Inform Discharge Disposition After Emergency Surgery?

Abstract

Older adults account for an increasing proportion of emergency surgical procedures and have longer hospital lengths of stay than their elective counterparts. Identifying those at greatest risk of discharge to a postacute care facility would improve postoperative planning. We aimed to examine the role of preoperative cognitive and functional status on discharge disposition after emergency surgery in older adults. We used American College of Surgeons National Surgical Quality Improvement Program Geriatric Pilot Project data from 2014 to 2018 to identify patients ≥65y who underwent inpatient emergency surgery. The primary outcome was nonhome discharge, defined as discharge to an acute rehabilitation facility, a skilled nursing facility, or a nonhome unskilled facility. Logistic regression controlling for patient characteristics was used to determine the association of preoperative geriatric-specific variables with nonhome discharge. Of 3494 patients, 53.9% were not discharged home. In multivariable analysis, a fall within the past year (odds ratio [OR] = 5.3, 95% confidence interval [CI] = 4.4-6.5) was most strongly associated with nonhome discharge. The outcome was also independently associated with preoperative use of a mobility aid (OR = 2.0, 95% CI = 1.7-2.4), partially dependent functional status (OR = 1.8, 95% CI = 1.4-2.5), and surrogate consent (OR = 1.4, 95% CI = 1.1-1.8), but not cognitive impairment (OR = 1.0, 95% CI = 0.7-1.3). Assessing for a history of falls and impaired mobility at the initial surgical evaluation can rapidly identify patients most likely to need postacute care. Further work is needed to assess the association between pre-existing cognitive impairment and discharge disposition after emergency surgery.