1. Older adults who undergo emergency general surgeries face similar rates of hospital use, days away from home and work, and one-year mortality rates compared to other acute medical patients
Evidence Rating Level: 2 (Good)
Pneumonia, myocardial infarction, and heart failure are common acute medical conditions that result in hospitalization, post-discharge hospital use, and days at home. However, emergency general surgery (EGS) accounts for 11% of hospitalizations and nearly 50% of these are patients are older adults at an increased risk of mortality and readmission following EGS. This retrospective, population-based cohort study utilizing Medicare claims data sought to determine whether or not these older adult EGS patients face similar outcomes compared to other medical patients. This study investigated a total of 481,417 matched patient pairs (mean 78.9 years, 56.6% female). Patients were admitted for one of the top five high-burden EGS procedures: partial colectomy, small-bowel resection, peptic ulcer disease surgery, lysis of adhesions, laparotomy; or an acute medical condition: pneumonia, heart failure, myocardial infarction. Researchers found that following in the 30 days post-discharge, EGS patients faced higher mortality (p<0.001) than acute medical patients. However, EGS patients faced a lower one-year mortality rate (p<0.001) than the matched medical patients. Regarding post-discharge hospital encounters, acute medical patients experienced higher rates (incidence rate ratio 1.31, 95% CI 1.30 to 1.32) but groups were similar in terms of mean days spent at home (incident rate ratio 1.004, 95% CI 1.004 to 1.004). This study therefore highlights the importance of considering older-adult EGS patients in quality improvement efforts, as they not only face similar outcomes to matched medical patients, but have a higher risk of mortality 30 days post-discharge.
Click to read the study in JAMA Surgery
Image: PD
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