Care for elderly after major surgery takes mental, physical preparation

Last Updated: 2016-05-09

By David Douglas

NEW YORK (Reuters Health) - After major abdominal surgery, elderly patients are often discharged to postacute care (PAC) facilities even when they are functionally independent and without postoperative complications.

"Helping older patients recover from surgery and make it home after leaving the hospital is much more complicated than most people think," Dr. Courtney Balentine told Reuters Health by email.

"It isn't enough to just avoid complications and deliver a technically proficient operation -- although those are important," she added. "We also need to focus on preparing patients mentally and physically for the rigors of surgery and do a better job helping them recover their independence while in the hospital."

In a May 4 online paper in JAMA Surgery, Dr. Balentine, of the University of Wisconsin, Madison, and colleagues reported that they examined data on more than 55,000 patients with a mean age of 61 years who underwent colorectal, pancreas, or liver operations between 2011 and 2012.

Overall, 5,325 (10%) were discharged to PAC facilities. Skilled nursing facilities were the most common (63%), followed by rehabilitation hospitals (30%), and other facilities (7%).

Being older was an important predictor of discharge to PAC facilities. Among functionally independent patients who avoided postoperative complications, rates of discharge to PAC increased from 1% in those younger than 65 to 30% in the group 85 or older. For such patients with multiple complications, corresponding proportions were 13% and 66%.

After risk adjustment, the oldest patients were 27 times more likely to be discharged to PAC than the youngest group when there were no postoperative complications, and 11 times more likely after multiple complications.

Among functionally dependent patients, the overall risk of discharge to PAC facilities was increased, but age was not as important a predictor for discharge to PAC.

"Because there is no opportunity to modify risk factors prior to the operation," wrote the researchers, "it is important to quickly identify patients who are at risk for discharge to PAC. If we identify patients with PAC needs early rather than later during their hospital stay, then there is adequate time for families and discharge planners to collaborate and identify the appropriate facility to address recovery needs."

Commenting on the findings by email, Dr. Emily Finlayson, coauthor of an accompanying invited commentary, told Reuters Health, "This study highlights the importance of factoring in patients' preoperative functional status in surgical decision-making and planning for care transitions."

Dr. Finlayson, of the University of California, San Francisco, concluded, "There is mounting evidence that poor physical function, not advanced age alone, is an important driver of surgical morbidity, mortality, and loss of independence after surgery."

The Conquer Cancer Foundation and the American Society of Clinical Oncology supported this research. The authors reported no disclosures.

SOURCE: http://bit.ly/24GtW4A and http://bit.ly/1TzqCjG

JAMA Surg 2016.