Geriatric-specific characteristics linked to hospital readmission risk of elderly surgical patients

Geriatric-specific characteristics linked to hospital readmission risk of elderly surgical patients

Researchers have examined new geriatric-specific characteristics that appear to raise the risk of elderly surgical patients having an unplanned hospital readmission within a month of initially leaving the hospital. The new study is published online as an "article in press" on the Journal of the American College of Surgeons website in advance of print publication. The four geriatric risk factors for readmission after general surgical procedures are cognitive impairment requiring another person to sign the patient's consent form for the operation (called "incompetent at admission"), use of a mobility aid, risk of falling at discharge from the hospital, and need for skilled home health care after going home. Our findings could impact clinical practice. It is not clear that hospitals are using geriatric variables in evaluating patients. Our results support screening for use of a mobility aid or having a surrogate sign consent when hospitals admit geriatric patients for surgical care." Florence E. Turrentine, PhD, RN, lead study author and associate professor in the department of surgery at the University of Virginia, Charlottesville Elderly individuals--those age 65 years or older--make up 43 percent of Americans undergoing an inpatient operation* and are more likely than younger patients to have postoperative complications, results of multiple studies show. More than one in 10 of the elderly patients in the new study had an unexpected readmission, according to study authors. "Readmissions are stressful and expensive and Medicare reduces payments to hospitals with excess readmissions," said R. Scott Jones, MD, MS, FACS, a study coauthor and emeritus professor and chair of the University of Virginia's surgery department. "We want to anticipate and hopefully prevent the reasons that contribute to unplanned readmission after an operation." The University of Virginia was among 25 participating centers in the Geriatric Surgery Pilot study, which the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP®) created in 2014 to collect risk factors and outcomes in surgical patients 65 and older. The NSQIP database is the leading nationally validated, risk-adjusted, outcomes-based program to measure and improve the quality of surgical care in hospitals. Using the first three years of data from that pilot study, Dr. Turrentine's research team tested 13 geriatric characteristics and 26 NSQIP risk factors for complications in 6,039 elderly general surgery patients from the NSQIP database. The investigators evaluated statistically significant predictors of readmission within 30 days following the operation, both overall and for each of five surgical procedure groups. The groups were surgical removal of part or all of the (1) pancreas or liver, (2) colon and/or rectum (comprising 58 percent of the patients), (3) hernia, (4) thyroid or esophagus, and (5) appendix . Readmission risk factors



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