1. The majority of patients 70 or older were discharged after non-elective abdominal surgery and returned to their pre-admission residential status within 6 months
2. Mean quality of life (QOL) scores significantly decreased among patients with change in residence status (loss of independence or institutionalization)
Evidence Rating Level: 2 (Good)
Study Rundown: One fourth of the in hospital population admitted for surgery will be older than 65 by 2050. As the general population continues to live longer many believe QOL is actually more important than the length of life after hospitalization. Therefore, discussions about post-discharge residence status are very important to provide more informed consent prior to undergoing procedures. In this paper the authors explored the outcome of residential status 6 months after discharge from non-elective abdominal surgeries and analyzed how that impacted QOL scores. The authors found that the majority of patients returned to their original residential status with 55% of those initially institutionalized ultimately returning to the community by 6 months.
Strengths of the study included multivariate analysis of procedure type and patient demographics on outcomes. Limitations included possible recall bias, lack of interval health outcomes between discharge and 6 months, and use of phone calls to measure residential status which could introduce ascertainment bias. This study highlights that while the majority of discharged patients did not suffer long term changes to residential status that required institutionalization, many do not continue to live alone.
Relevant Reading: Optimal preoperative assessment of the geriatric surgical patient: a best practices guideline from the American College of Surgeons National Surgical Quality Improvement Program and the American Geriatrics Society
In-Depth [outcomes study]: This study analyzed the residence status of geriatric patients admitted from the community after non-elective abdominal surgeries. 197 patients from Nova Scotia were included in the study with a median age of 77 and the most common surgeries were small bowel resections and biliary procedures. Patients were excluded if admitted from an institution, if the admission was due to complications from prior elective procedures, or if they died during admission. The majority of patients living co-dependent in the community returned to living with others (77%) but only 61% of patients living alone returned to living alone at 6 months. Patients discharged to institutions had several risk factors including increased F1 score, ASA score, age and surgery for malignancy, pre-op steroid use, and the need for blood products. 55% of all patients discharged to institutions returned to the community. Spitzer Quality of Life Index was used (scored 0-14) and found any institutionalization decreased QOL (10.3 ± 2.1 vs non-institutionalized 11.8 ± 1.9; P < 0.0001). Even more importantly, of patients continuing to be institutionalized at 6 months 20.5%(9/44) had QOL 6.8 ± 3.2 vs non-institutionalized 9.3 ± 2.5(P = 0.03). QOL scores also decreased (9.85 ± 3.77 vs 11.6 ± 2.67; P < 0.001) in relation to decreased level of activity, cognitive ability and social engagement among others.
More from this author: The ZEUS study: everolimus maintains durable renal transplant function; Thromboelastography velocity better for predicting hyperfibrinolysis in trauma; Previous stroke may increase risk of complications after major surgery
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