Older Patients Associated With Inability To Return Home

Older patients have a different physiology and unique set of needs that may make them more vulnerable to complications following a surgical procedure. The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) Geriatric Surgery Pilot Project has, for the first time, identified four factors in older patients that are associate with an inability to return home after an operation. The NSQIP Geriatric Surgery Pilot Project is unique in that it is the only specifically define data set focus on outcomes for older surgical patients.

In presenting study results at the ACS Quality and Safety Conference 2019; so concluding today in Washington, DC, researchers report on geriatric-specific condition; so among Geriatric Pilot Project patients that were with not living at home 30 days after surgery. This information can help surgeons advise patients about; so the possible effects of a surgical procedure on their lifestyle as well as their clinical outcomes before an operation.

It also may guide hospital quality improvement programs to address pre and postoperative conditions; so that may keep elderly surgical patients from returning home soon afterward. “When surgeons speak with older patients about the decision to operate,  discuss complication rates and the risk of mortality. They don’t usually talk about whether; so they will have the independence they had beforehand.

This information should help us make better preoperative decisions with our patients; which by allowing us to tell them about the impact a surgical procedure will have on their way of life,” said study coauthor Ronnie Rosenthal, MD, FACS, co-principal investigator of the ACS-led Coalition for Quality in Geriatric Surgery (CQGS) and professor of surgery and geriatrics, Yale University School of Medicine, New Haven, CT.

Improve patient function

“Hospitals may implement protocols that improve patient function or prevent postoperative problems; so that make it less likely for a patient to return home,” said study co-author Lindsey Zhang, MD, MS, John A. Hartford Foundation James C. Thompson Clinical Scholar in Residence at ACS, and a general surgery resident at the University of Chicago Medical Center.

The researchers look at 3,696 patients in the NSQIP Geriatric Surgery Pilot registry; who who had inpatient procedures between 2015 and 2017 and whose living location 30 days after surgery was know. Eighteen percent of these patients were still living in a care facility 30 days after surgical treatment. The four characteristics identify among these older patients were: a history of a fall within the past year, preoperative malnutrition as define by more than 10% of unintentional weight loss; so postoperative delirium, or a new or worsening pressure ulcer after surgery.

They can’t say for sure, but these results provide strong evidence to say it’s worth the effort for a hospital to address these issues,” Dr. Zhang said. On July 19, the ACS introduce the Geriatric Surgery Verification (GSV) Program by releasing the GSV standards for geriatric surgical care for hospitals to review prior to enrolling in this new surgical quality improvement program in late October. These standards address many key factors in geriatric surgery, including those that may delay an older patient’s return home postoperatively.