Mortality and Health Care Utilization Among Medicare Patients Undergoing Emergency General Surgery vs Those With Acute Medical Conditions

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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