Sacks Greg D, Lawson Elise H, Dawes Aaron J, Gibbons Melinda M, Zingmond David S, Ko Clifford Y
Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, CA; VA Greater Los Angeles Healthcare System, Los Angeles, CA.
Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, CA.
J Am Coll Surg. 2015 Jun;220(6):1113-1121.e2. doi: 10.1016/j.jamcollsurg.2015.02.029. Epub 2015 Mar 14.
The use of post-acute care is common among the elderly and accounts for $62 billion in annual Medicare expenditures. However, little is known about post-acute care use after surgery.
Data were merged between the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) and Medicare claims for 2005 to 2008. Post-acute care use, including skilled nursing facilities (SNF), inpatient rehabilitation facilities (IRF), and home health care (HHC) were analyzed for 3 operations: colectomy, pancreatectomy, and open abdominal aortic aneurysm repair. Controlling for both preoperative risk factors and the occurrence of postoperative complications, we used multinomial logistic regression to estimate the odds of use for each type of post-acute care after elective surgery compared with home discharge.
Post-acute care was used frequently for patients undergoing colectomy (40.0%; total n=10,932), pancreatectomy (46.0%; total n=2,144), and open abdominal aortic aneurysm (AAA) repair (44.9%; total n=1,736). Home health was the most frequently reported post-acute care service for each operation (range 23.2% to 31.5%) followed by SNF (range 12.0% to 15.0%), and then by IRF (range 2.5% to 5.4%). The majority of patients with at least 1 inpatient complication were discharged to post-acute care (range 58.6% for open AAA repair to 64.4% for colectomy). In multivariable analysis, specific preoperative risk factors, including advanced age, poor functional status, and inpatient complications were significantly associated with increased risk-adjusted odds of discharge to post-acute care for each operation studied.
Among elderly patients, post-acute care use is frequent after surgery and is significantly associated with several preoperative risk factors and postoperative inpatient complications. Further work is needed to ensure that post-acute care services are used appropriately and cost-effectively.
急性后期护理在老年人中使用普遍，每年医疗保险支出达620亿美元。然而，对于术后急性后期护理的使用情况知之甚少。
将美国外科医师学会国家外科质量改进计划（ACS-NSQIP）与2005年至2008年的医疗保险索赔数据进行合并。对结肠切除术、胰腺切除术和开放性腹主动脉瘤修复术这3种手术的急性后期护理使用情况进行分析，包括熟练护理设施（SNF）、住院康复设施（IRF）和家庭健康护理（HHC）。在控制术前风险因素和术后并发症发生情况的基础上，我们使用多项逻辑回归来估计择期手术后与出院回家相比，每种急性后期护理类型的使用几率。
接受结肠切除术（40.0%；总数n = 10932）、胰腺切除术（46.0%；总数n = 2144）和开放性腹主动脉瘤（AAA）修复术（44.9%；总数n = 1736）的患者经常使用急性后期护理。家庭健康护理是每种手术最常报告的急性后期护理服务（范围为23.2%至31.5%），其次是熟练护理设施（范围为12.0%至15.0%），然后是住院康复设施（范围为2.5%至5.4%）。大多数至少有1种住院并发症的患者出院后接受急性后期护理（开放性AAA修复术为58.6%，结肠切除术为64.4%）。在多变量分析中，特定的术前风险因素，包括高龄、功能状态差和住院并发症，与所研究的每种手术调整风险后出院接受急性后期护理的几率增加显著相关。
在老年患者中，术后急性后期护理使用频繁，且与多种术前风险因素和术后住院并发症显著相关。需要进一步开展工作以确保急性后期护理服务得到适当且具有成本效益的使用。
