Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
Tufts Medical Center and University School of Medicine, Boston, MA, USA.
J Appl Gerontol. 2021 Aug;40(8):856-864. doi: 10.1177/0733464820944699. Epub 2020 Aug 1.
To identify patient risk factors for nonhome discharge (NHD) for home-dwelling older patients undergoing surgery, we performed a retrospective cohort study of patients aged ≥65 years undergoing elective surgery between 2014 and 2016 using the geriatric research file from the National Surgical Quality Improvement Program (NSQIP). Multivariable logistic regression examined the association between preoperative demographics, comorbidities, and functional status and NHD to determine which factors are most strongly predictive of NHD. Risk of NHD was higher among those of age >85 years, age 75 to 85 years, Black race, with body mass index (BMI) >30, dyspnea with exertion or at rest, partially or totally dependent in activities of daily living (ADLs), preoperative steroid use, preoperative wound infection, use of a mobility aid, fall within 3 months, or living alone at home without support. NHDs were statistically more likely among orthopedic, neurosurgery, or cardiac surgery interventions. Understanding individual patient's risks and setting expectations for likely postoperative course is integral to appropriate preoperative counseling and preoperative optimization.
为了确定接受手术的居家老年患者非居家出院（NHD）的患者风险因素，我们使用国家手术质量改进计划（NSQIP）老年研究档案，对 2014 年至 2016 年间接受择期手术的年龄≥65 岁的患者进行了回顾性队列研究。多变量逻辑回归检查了术前人口统计学、合并症和功能状态与 NHD 之间的关联，以确定哪些因素对 NHD 的预测性最强。年龄>85 岁、75 至 85 岁、黑种人、身体质量指数（BMI）>30、活动时或休息时呼吸困难、部分或完全依赖日常生活活动（ADL）、术前使用类固醇、术前伤口感染、使用移动辅助工具、3 个月内跌倒或独居在家无支持的患者，其 NHD 的风险更高。骨科、神经外科或心脏外科干预的 NHD 更有可能出现统计学差异。了解个体患者的风险并为可能的术后过程设定预期，是适当的术前咨询和术前优化的重要组成部分。
