Loss of Community-Dwelling Status Among Survivors of High-Acuity Emergency General Surgery Disease.

A new interesting article has been published in J Am Geriatr Soc. 2019 Jul 13. doi: 10.1111/jgs.16046. and titled:

Loss of Community-Dwelling Status Among Survivors of High-Acuity Emergency General Surgery Disease.

Authors of this article are:

Smith JW, Knight Davis J, Quatman-Yates CC, Waterman BL, Strassels SA, Wong JD, Heh VK, Baselice HE, Brock GN, Clark BC, Bridges JFP, Santry HP.

A summary of the article is shown below:

OBJECTIVES: To examine loss of community-dwelling status 9 months after hospitalization for high-acuity emergency general surgery (HA-EGS) disease among older Americans.DESIGN: Retrospective analysis of claims data.SETTING: US communities with Medicare beneficiaries.PARTICIPANTS: Medicare beneficiaries age 65 years or older hospitalized urgently/emergently between January 1, 2015, and March 31, 2015, with a principal diagnosis representing potential life or organ threat (necrotizing soft tissue infections, hernias with gangrene, ischemic enteritis, perforated viscus, toxic colitis or gastroenteritis, peritonitis, intra-abdominal hemorrhage) and an operation of interest on hospital days 1 or 2 (N = 3319).MEASUREMENTS: Demographic characteristics (age, race, and sex), comorbidities, principal diagnosis, complications, and index hospitalization disposition (died; discharged to skilled nursing facility [SNF], long-term acute care [LTAC], rehabilitation, hospice, home (with or without services), or acute care hospital; other) were measured. Survivors of index hospitalization were followed until December 31, 2015, on mortality and community-dwelling status (SNF/LTAC vs not). Descriptive statistics, Kaplan-Meier plots, and χ2 tests were used to describe and compare the cohort based on disposition. A multivariable logistic regression model, adjusted for age, sex, comorbidities, complications, and discharge disposition, determined independent predictors of loss of community-dwelling status at 9 months.RESULTS: A total of 2922 (88%) survived index hospitalization. Likelihood of discharge to home decreased with increasing age, baseline comorbidities, and in-hospital complications. Overall, 418 (14.3%) HA-EGS survivors died during the follow-up period. Among those alive at 9 months, 10.3% were no longer community dwelling. Initial discharge disposition to any location other than home and three or more surgical complications during index hospitalization were independent predictors of residing in a SNF/LTAC 9 months after surviving HA-EGS.CONCLUSION: Older Americans, known to prioritize living in the community, will experience substantial loss of independence due to HA-EGS. Long-term expectations after surviving HA-EGS must be framed from the perspective of the outcomes that older patients value the most. Further research is needed to examine the quality-of-life burden of EGS survivorship prospectively.© 2019 The American Geriatrics Society.

Check out the article’s website on Pubmed for more information:

[link-preview url=https://www.ncbi.nlm.nih.gov/pubmed/31301180 forceshot=true]

This article is a good source of information and a good way to become familiar with topics such as: community-dwelling status;emergency general surgery;quality of life.

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