Healthy Days at Home after Emergency General Surgery: Shifting Toward Long-Term Patient-Centered Outcomes for Older Adults.

Abstract

Emergency general surgery (EGS) in older adults is commonly evaluated with short-term outcomes that may not reflect functional recovery. Healthy days at home (HDAH) captures time alive and living outside institutional care and may better reflect patient-centered recovery after EGS. We performed a retrospective cohort study using 2017 100% Medicare fee-for-service claims with a 1-year look-back and follow-up. Community-dwelling adults aged 66 years and older who underwent 1 of 7 EGS procedures within 48 hours of urgent or emergent admission were identified and stratified as low risk (appendectomy, cholecystectomy) or high risk (laparotomy, colectomy, small bowel resection, peptic ulcer repair, lysis of adhesions). HDAH were calculated from surgery through 365 days, subtracting days spent deceased, hospitalized, in the emergency department, rehabilitation or nursing home, home healthcare, or hospice. Multivariable linear regression identified factors associated with HDAH overall and by procedural risk. Among 29,828 older adults, 32.95% underwent a high-risk procedure. Mean HDAH was lower after high-risk vs low-risk EGS (307.88 [SD 119.32] vs 345.30 [SD 71.54] days, p < 0.001). One-year mortality was higher after high-risk procedures (18.10% vs 5.21%, p < 0.001). Fewer HDAH were independently associated with age (Coef. -2.28, 95% CI -2.43 to -2.14), Black race (Coef. -8.30, 95% CI -12.89 to -3.71), dementia (Coef. -49.74, 95% CI -53.97 to -45.50), 2 or more comorbidities (Coef. -16.34, 95% CI -20.81 to -11.87), and frailty. Dementia was associated with a greater reduction in HDAH after low-risk vs high-risk procedures. High-risk EGS was associated with approximately 1-month fewer HDAH in older adults. Dementia and frailty were major predictors of reduced HDAH and should inform patient-centered perioperative counseling.