title: Risk factors for nursing home placement following major nonemergent surgery.
abstract: OBJECTIVE
  To determine the association between self-reported exercise tolerance and the risk of unanticipated postoperative nursing home placement in adults undergoing major surgery.
  
  
  METHODS
  Consecutive community-dwelling adults (N = 586) referred to a medical clinic for evaluation before undergoing major nonemergent surgery at a tertiary care academic medical center were prospectively followed between 1995 and 1997. The main outcome measure was unanticipated postoperative nursing home placement.
  
  
  RESULTS
  Overall, 12% (40/324) of patients with poor preoperative exercise tolerance (inability to walk four blocks and climb two flights of stairs without symptomatic limitation) had unanticipated nursing home placement compared with 4% (10/262) of patients with good exercise tolerance. Patient and surgical characteristics associated with nursing home placement in univariate analyses included poor preoperative exercise tolerance, increasing age, living alone, history of heart failure, taking five or more preoperative medications, longer anesthesia duration, and orthopedic surgery. Patients who were married were at lower risk. After adjusting for all other patient and surgical factors, poor preoperative exercise tolerance (odds ratio [OR] = 2.8; 95% confidence interval [CI]: 1.3 to 6.2) and serious postoperative complications (OR = 4.7; 95% CI: 2.1 to 10.5) remained associated with postoperative nursing home placement.
  
  
  CONCLUSIONS
  Poor preoperative exercise tolerance was an independent predictor of unanticipated nursing home placement following major nonemergent surgery.
authors.affiliation: Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA. legner@u.washington.edu
authors.forename: Victor J
authors.initials: VJ
authors.lastname: Legner
authors.forename: Diane
authors.initials: D
authors.lastname: Doerner
authors.forename: Dominic F
authors.initials: DF
authors.lastname: Reilly
authors.forename: Wayne C
authors.initials: WC
authors.lastname: McCormick
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004638:Emergency Treatment; D017079:Exercise Tolerance / Q000502:physiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009735:Nursing Homes; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D011237:Predictive Value of Tests; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D013223:Statistics as Topic; D013514:Surgical Procedures, Operative; D016896:Treatment Outcome; D014861:Washington / Q000453:epidemiology