National Clinical Programme in Surgery, Royal College of Surgeons in Ireland, 2 Proud's Lane, Dublin, Ireland.
Healthcare Outcomes Research Centre, Royal College of Surgeons in Ireland, Beaux Lane House, Mercer Street Lower, Dublin, Ireland.
BMC Geriatr. 2020 Feb 19;20(1):72. doi: 10.1186/s12877-020-1469-4.
Intra-abdominal emergency surgery is associated with high mortality risk and long length of hospital stay. The objective of this study was to explore variations in surgery rates, the relationship between admission source and discharge destination, and whether the postoperative length of stay was related to nursing home capacity in Irish counties.
Data on emergency hospital episodes for 2014-18 for patients aged over 65 years with a primary abdominal procedure code were obtained from the National Quality Assurance Improvement System. Data on population and nursing home capacity were obtained from the Central Statistics Office and the Health Information and Quality Authority. Episode rates per 100,000 were estimated for sex and age groups and compared between 26 Irish counties. The association between admission source and discharge destination was explored in terms episode numbers, length of stay and mortality. A negative binomial regression model estimated casemix adjusted excess post-operative length of stay. The correlation between excess post-operative length of stay and nursing home capacity was explored by linear regression.
Overall, 4951 hospital episodes were included. The annual surgery rate ranged from 100 episodes per 100,000 65-69 years old to 250 per 100,000 85-89 year old men. 90% of the episodes were admitted from patients' home. Four in five of these patients returned to their home while 12.7% died at hospital. The proportion of episodes where patients returned to their home reduced to two in five for those aged 85-89 years. The post-operative length of stay was 13.6 days longer (p < 0.01) for episodes admitted from home and discharged to nursing home in comparison with episodes discharged home. A negative association (p = 0.08) was found between excess post-operative length of stay and county-level nursing home capacity.
This study provides relevant information to support informed consent to surgery for patients and clinicians and to improve the provision of care to older patients presenting with intra-abdominal emergencies.
腹腔内急诊手术与高死亡率和较长的住院时间相关。本研究旨在探讨手术率的变化，入院来源与出院去向的关系，以及术后住院时间是否与爱尔兰县的养老院容量有关。
从国家质量保证改进系统获取了 2014-18 年年龄在 65 岁以上、主要腹部手术编码的急诊住院患者的数据。人口和养老院容量的数据来自中央统计局和健康信息与质量管理局。按性别和年龄组估计了每 10 万人的住院率，并在 26 个爱尔兰县之间进行了比较。根据住院人数、住院时间和死亡率，探讨了入院来源与出院去向的关系。使用负二项回归模型估计了病例组合调整后的术后住院时间过长的校正超额值。通过线性回归探讨了术后住院时间过长与养老院容量之间的相关性。
共有 4951 例住院患者。手术率每年从 100 例/10 万 65-69 岁男性到 250 例/10 万 85-89 岁男性不等。90%的患者从患者家中入院。其中五分之四的患者返回家中，而 12.7%的患者在医院死亡。对于 85-89 岁的患者，返回家中的患者比例降至五分之二。与出院回家的患者相比，从家中入院并出院到养老院的患者术后住院时间延长了 13.6 天（p<0.01）。发现术后住院时间过长与县级养老院容量呈负相关（p=0.08）。
本研究提供了相关信息，以支持对手术的知情同意，使患者和临床医生能够做出明智的决策，并改善对出现腹腔内急症的老年患者的护理。
