TY - JOUR
T1 - Discharge disposition to skilled nursing facility after emergent general surgery predicts a poor prognosis
AU - Paredes, Anghela Z.
AU - Malik, Azeem T.
AU - Cluse, Marcus
AU - Strassels, Scott A.
AU - Santry, Heena P.
AU - Eiferman, Daniel
AU - Jones, Christian
AU - Vazquez, Daniel
N1 - Funding Information:
The ACS NSQIP and hospitals participating in the ACS NSQIP are the source of the data used. They have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors. We acknowledge H.P.S has received grant support from the Agency for Healthcare Research and Quality (R01HS022694). She is a paid consultant by the Johnson & Johnson Company on a fragility fracture advisory board. The submitted work is not related to this topic. No other disclosures.
Funding Information:
The ACS NSQIP and hospitals participating in the ACS NSQIP are the source of the data used. They have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors. We acknowledge H.P.S has received grant support from the Agency for Healthcare Research and Quality ( R01HS022694 ). She is a paid consultant by the Johnson & Johnson Company on a fragility fracture advisory board. The submitted work is not related to this topic. No other disclosures.
Publisher Copyright:
© 2019 Elsevier Inc.
PY - 2019/10
Y1 - 2019/10
N2 - Background: Emergency general surgery can have a profound impact on the functional status of even previously independent patients. The role and influence of discharging a patient to a skilled nursing facility, however, remains largely unknown. Methods: We queried the American College of Surgeons National Surgical Quality Improvement Program for community-dwelling adults who underwent 1 of 7 emergency general surgery procedures and were discharged home or to a skilled nursing facility from 2012 to 2016. Propensity score matching and multivariable regression analyses were performed to determine the relationship between discharge disposition and outcomes. Results: Overall, 140,922 patients met the inclusion criteria. The majority were discharged home (95.9%). After applying 1:1 propensity score matching, in comparison to patients discharged home, individuals discharged to a skilled nursing facility had a greater odds of respiratory (odds ratio 2.32; 95% confidence interval, 1.59–3.38) and septic complications (odds ratio 1.63, 95% confidence interval 1.12–2.36) after discharge. Furthermore, following surgery, individuals discharged to a skilled nursing facility had a greater odds of 30-day readmission (odds ratio 1.14; 95% confidence interval, 1.01–1.29), and death within 30 days of the procedure (odds ratio 2.07; 95% confidence interval, 1.65–2.61). Conclusion: After accounting for patient severity and perioperative course, discharge to a skilled nursing facility is an independent risk factor for death, readmission, and postdischarge complications.
AB - Background: Emergency general surgery can have a profound impact on the functional status of even previously independent patients. The role and influence of discharging a patient to a skilled nursing facility, however, remains largely unknown. Methods: We queried the American College of Surgeons National Surgical Quality Improvement Program for community-dwelling adults who underwent 1 of 7 emergency general surgery procedures and were discharged home or to a skilled nursing facility from 2012 to 2016. Propensity score matching and multivariable regression analyses were performed to determine the relationship between discharge disposition and outcomes. Results: Overall, 140,922 patients met the inclusion criteria. The majority were discharged home (95.9%). After applying 1:1 propensity score matching, in comparison to patients discharged home, individuals discharged to a skilled nursing facility had a greater odds of respiratory (odds ratio 2.32; 95% confidence interval, 1.59–3.38) and septic complications (odds ratio 1.63, 95% confidence interval 1.12–2.36) after discharge. Furthermore, following surgery, individuals discharged to a skilled nursing facility had a greater odds of 30-day readmission (odds ratio 1.14; 95% confidence interval, 1.01–1.29), and death within 30 days of the procedure (odds ratio 2.07; 95% confidence interval, 1.65–2.61). Conclusion: After accounting for patient severity and perioperative course, discharge to a skilled nursing facility is an independent risk factor for death, readmission, and postdischarge complications.
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U2 - 10.1016/j.surg.2019.04.034
DO - 10.1016/j.surg.2019.04.034
M3 - Article
C2 - 31326186
AN - SCOPUS:85069046266
SN - 0039-6060
VL - 166
SP - 489
EP - 495
JO - Surgery (United States)
JF - Surgery (United States)
IS - 4
ER -