Predictors of Postacute Care Discharge in Older Adult Emergency General Surgery: A Nationwide Analysis.

INTRODUCTION

Older adults undergoing emergency general surgery (EGS) represent a particularly high-risk population. We aimed to identify predictors of discharge to postacute care facilities in older adult EGS patients.

METHODS

We used the 2013-2019 American College of Surgeons National Surgical Quality Improvement Program database to identify all EGS patients ≥ 65 y of age presenting directly from home. The primary outcome was nonroutine discharge, defined as discharge to a postacute care facility. Nonsurvivors and patients transferred from health care facilities were excluded. Bidirectional stepwise multivariable logistic regression was used to investigate the effect of patient characteristics, preoperative factors, and operative factors on the risk of nonroutine discharge.

RESULTS

Of 55,246 included patients, 22.7% were discharged to a postacute care facility. The median age was 74 (69-81) y. On multivariable analyses, patient characteristics predicting nonroutine discharge were age ≥ 85 (adjusted odds ratio [aOR]: 4.53, confidence interval [CI]: 4.14-4.95), increasing frailty (aOR: 2.49, CI: 2.10-2.95), female sex (aOR: 1.44, CI: 1.36-1.54), Black race (aOR: 1.14, CI: 1.03-1.25), body mass index < 18.5 kg/m2 (aOR: 1.18, CI: 1.01-1.37) or ≥ 30 kg/m2 (aOR: 1.13, CI: 1.04-1.22), disseminated cancer (aOR: 1.18, CI: 1.02-1.35), bleeding disorder (aOR: 1.24, CI: 1.14-1.35), and chronic steroid use (aOR: 1.18, CI: 1.05-1.31). Preoperative factors associated with nonroutine discharge were American Society of Anesthesiologists physical status ≥ 3 (aOR: 2.51, CI: 2.28-2.77), sepsis (aOR: 1.65, CI: 1.52-1.79), blood transfusion (aOR: 1.61, CI: 1.38-1.87), and ventilator dependence (aOR: 2.60, CI: 1.93-3.49). Operative factors predicting nonroutine discharge were open surgical approach (aOR: 3.38, CI: 3.13-3.64) and contaminated (aOR: 2.24, CI: 1.99-2.51) or dirty (aOR: 2.95, CI: 2.65-3.30) wound class.

CONCLUSIONS

Identifying key predictors of nonroutine discharge early in the clinical course may support informed decision-making and facilitate discharge planning for older adults undergoing EGS procedures.