Panossian Vahe S, Abiad May, Proaño Jefferson, Lagazzi Emanuele, Nzenwa Ikemsinachi C, Rafaqat Wardah, Arnold Suzanne, van Zon Veerle P C, Luckhurst Casey, Parks Jonathan J, DeWane Michael P, Velmahos George C, Hwabejire John O
Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
Department of Surgery, Humanitas Research Hospital, Rozzano, Italy.
Eur J Trauma Emerg Surg. 2025 Jan 14;51(1):14. doi: 10.1007/s00068-024-02750-1.
This study aims to identify predictors of discharge to post-acute care in geriatric emergency general surgery (EGS) patients.
This is a retrospective study of geriatric emergency general surgery (EGS) patients at a tertiary care facility between 2017 and 2018. Inclusion criteria were ≥ 65 years old and presented directly from home. Non-survivors or those admitted from a healthcare facility were excluded. The primary outcome was discharge to home versus post-acute care.
Out of 577 patients, the median age was 74, and 36.9% were discharged to a post-acute care facility. Factors predicting discharge to post-acute care were: mobility aid use (1.92, [1.19-3.11], p = 0.008), cerebrovascular accident (4.67, [1.99-10.94], p < 0.001), delirium (11.06, [2.29-53.43], p = 0.003), pre-operative transfusion (2.39, [1.13-5.08], p = 0.023), fall history (3.74, [1.90-7.36], p < 0.001), AKI (5.42, [2.61-11.25], p < 0.001), and lack of capacity to consent (4.11, [2.10-8.02], p < 0.001). Non-operative management was protective against discharge to post-acute care (0.38, [0.24-0.60], p < 0.001).
Early recognition of the role of these factors in influencing discharge disposition may help with clinical decision-making and discharge planning.
本研究旨在确定老年急诊普通外科（EGS）患者出院后接受急性后期护理的预测因素。
这是一项对2017年至2018年期间在一家三级医疗机构接受老年急诊普通外科（EGS）治疗的患者进行的回顾性研究。纳入标准为年龄≥65岁且直接从家中就诊。非幸存者或从医疗机构入院的患者被排除。主要结局是出院回家与接受急性后期护理。
在577例患者中，中位年龄为74岁，36.9%的患者出院后进入急性后期护理机构。预测出院后接受急性后期护理的因素包括：使用行动辅助器具（1.92，[1.19 - 3.11]，p = 0.008）、脑血管意外（4.67，[1.99 - 10.94]，p < 0.001）、谵妄（11.06，[2.29 - 53.43]，p = 0.003）、术前输血（2.39，[1.13 - 5.08]，p = 0.023）、跌倒史（3.74，[1.90 - 7.36]，p < 0.001）、急性肾损伤（5.42，[2.61 - 11.25]，p < 0.001）以及缺乏同意能力（4.11，[2.10 - 8.02]，p < 0.001）。非手术治疗对出院后接受急性后期护理具有保护作用（0.38，[0.24 - 0.60]，p < 0.001）。
尽早认识这些因素在影响出院处置方面的作用，可能有助于临床决策和出院计划的制定。
