Department of Surgery, University of Louisville, Louisville, Kentucky.
Department of Surgery, West Virginia University, Morgantown, West Virginia.
J Am Geriatr Soc. 2019 Nov;67(11):2289-2297. doi: 10.1111/jgs.16046. Epub 2019 Jul 13.
To examine loss of community-dwelling status 9 months after hospitalization for high-acuity emergency general surgery (HA-EGS) disease among older Americans.
Retrospective analysis of claims data.
US communities with Medicare beneficiaries.
Medicare beneficiaries age 65 years or older hospitalized urgently/emergently between January 1, 2015, and March 31, 2015, with a principal diagnosis representing potential life or organ threat (necrotizing soft tissue infections, hernias with gangrene, ischemic enteritis, perforated viscus, toxic colitis or gastroenteritis, peritonitis, intra-abdominal hemorrhage) and an operation of interest on hospital days 1 or 2 (N = 3319).
Demographic characteristics (age, race, and sex), comorbidities, principal diagnosis, complications, and index hospitalization disposition (died; discharged to skilled nursing facility [SNF], long-term acute care [LTAC], rehabilitation, hospice, home (with or without services), or acute care hospital; other) were measured. Survivors of index hospitalization were followed until December 31, 2015, on mortality and community-dwelling status (SNF/LTAC vs not). Descriptive statistics, Kaplan-Meier plots, and χ tests were used to describe and compare the cohort based on disposition. A multivariable logistic regression model, adjusted for age, sex, comorbidities, complications, and discharge disposition, determined independent predictors of loss of community-dwelling status at 9 months.
A total of 2922 (88%) survived index hospitalization. Likelihood of discharge to home decreased with increasing age, baseline comorbidities, and in-hospital complications. Overall, 418 (14.3%) HA-EGS survivors died during the follow-up period. Among those alive at 9 months, 10.3% were no longer community dwelling. Initial discharge disposition to any location other than home and three or more surgical complications during index hospitalization were independent predictors of residing in a SNF/LTAC 9 months after surviving HA-EGS.
Older Americans, known to prioritize living in the community, will experience substantial loss of independence due to HA-EGS. Long-term expectations after surviving HA-EGS must be framed from the perspective of the outcomes that older patients value the most. Further research is needed to examine the quality-of-life burden of EGS survivorship prospectively. J Am Geriatr Soc 67:2289-2297, 2019.
研究美国老年人因急症普通外科（HA-EGS）疾病住院 9 个月后丧失社区居住能力的情况。
索赔数据的回顾性分析。
美国有医疗保险受益人的社区。
2015 年 1 月 1 日至 2015 年 3 月 31 日期间因潜在生命或器官威胁的主要诊断而紧急/紧急住院的年龄在 65 岁或以上的医疗保险受益人（坏死性软组织感染、伴有坏疽的疝、缺血性肠炎、穿孔内脏、中毒性结肠炎或肠胃炎、腹膜炎、腹腔内出血）和在入院第 1 或第 2 天进行感兴趣的手术（N=3319）。
人口统计学特征（年龄、种族和性别）、合并症、主要诊断、并发症和指数住院处置（死亡；出院到熟练护理机构[SNF]、长期急性护理[LTAC]、康复、临终关怀、家庭（有或没有服务）或急性护理医院；其他）。对指数住院的幸存者进行随访，直至 2015 年 12 月 31 日，以了解死亡率和社区居住能力（SNF/LTAC 与非 SNF/LTAC）。描述性统计、Kaplan-Meier 图和 χ 检验用于根据处置情况描述和比较队列。多变量逻辑回归模型，调整年龄、性别、合并症、并发症和出院处置，确定 9 个月时丧失社区居住能力的独立预测因素。
共有 2922 人（88%）存活下来。出院到家庭的可能性随着年龄的增长、基线合并症和院内并发症的增加而降低。总的来说，在随访期间有 418 人（14.3%）HA-EGS 幸存者死亡。在存活 9 个月的幸存者中，有 10.3%不再居住在社区。初始出院处置到家庭以外的任何地方和指数住院期间发生 3 个或更多手术并发症是存活 HA-EGS 后居住在 SNF/LTAC 9 个月的独立预测因素。
众所周知，美国老年人优先考虑在社区生活，而急症普通外科（HA-EGS）会导致他们丧失相当大的独立性。在 HA-EGS 后存活下来的情况下，必须从老年患者最看重的结果角度来制定长期预期。需要进一步研究前瞻性地检查 EGS 生存者的生活质量负担。美国老年学会杂志 67：2289-2297，2019。
