Abstract
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.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- National Diabetes Statistics Report: Estimates of Diabetes and Its Burden in the United States.National Center for Chronic Disease Prevention and Health Promotion, Atlanta, GA2017
- SEER Cancer Statistics Review, 1975–2015.National Cancer Institute, Bethesda, MD2017
- The public health burden of emergency general surgery in the United States: A 10-year analysis of the Nationwide Inpatient Sample—2001 to 2010.J Trauma Acute Care Surg. 2014; 77: 202-208
- The financial burden of emergency general surgery: National estimates 2010 to 2060.J Trauma Acute Care Surg. 2015; 79: 444-448
- The excess morbidity and mortality of emergency general surgery.J Trauma Acute Care Surg. 2015; 78: 306-311
- Factors affecting morbidity in emergency general surgery.Am J Surg. 2011; 201: 456-462
- Impact of specific postoperative complications on the outcomes of emergency general surgery patients.J Trauma Acute Care Surg. 2015; 78 (discussion 918–919): 912-918
- Emergency general surgery in the elderly: Too old or too frail?.J Am Coll Surg. 2016; 222: 805-813
- Defining rates and risk factors for readmissions following emergency general surgery.JAMA Surg. 2016; 151: 330-336
- Impact of skilled nursing facility quality on postoperative outcomes after pancreatic surgery.Surgery. 2019; 166: 1-7
- Use of national burden to define operative emergency general surgery.JAMA Surg. 2016; 151e160480
- The independent effect of emergency general surgery on outcomes varies depending on case type: A NSQIP outcomes study.Am J Surg. 2018; 216: 856-862
- Optimizing ACS NSQIP modeling for evaluation of surgical quality and risk: Patient risk adjustment, procedure mix adjustment, shrinkage adjustment, and surgical focus.J Am Coll Surg. 2013; 217 (e331): 336-346
- Practical guide to surgical data sets: National Surgical Quality Improvement Program (NSQIP) and Pediatric NSQIP.JAMA Surg. 2018; 153: 764-765
- Characterizing functional health status of surgical patients in clinical notes.AMIA Jt Summits Transl Sci Proc. 2018; 2017: 379-388
- Transferred emergency general surgery patients are at increased risk of death: A NSQIP propensity score matched analysis.J Am Coll Surg. 2019; 228: 871-877
- Care transitions between hospitals and skilled nursing facilities: Perspectives of sending and receiving providers.Jt Comm J Qual Patient Saf. 2017; 43: 565-572
- The association between skilled nursing facility care quality and 30-day readmission rates after hospitalization for heart failure.Am J Med Qual. 2015; 30: 205-213
- Hospital-skilled nursing facility referral linkage reduces readmission rates among Medicare patients receiving major surgery.Surgery. 2016; 159: 1461-1468
- Comparison of risk adjustment methodologies in surgical quality improvement.Surgery. 2008; 144: 662-667
- A comparison of the ability of different propensity score models to balance measured variables between treated and untreated subjects: A Monte Carlo study.Stat Med. 2007; 26: 734-753
Article info
Publication history
Published online: July 18, 2019
Accepted:
April 8,
2019
Identification
Copyright
© 2019 Elsevier Inc. All rights reserved.
