title: The significance of discharge to skilled care after abdominopelvic surgery in older adults.
abstract: BACKGROUND
  Older adults frequently undergo abdominopelvic surgical operations, yet the risk and significance of postoperative discharge disposition has not been well characterized.
  
  
  OBJECTIVE
  To describe the population-level risk of discharge to institutional care facilities and its impact on survival among older patients who undergo common abdominopelvic surgical procedures.
  
  
  METHODS
  A retrospective, population-based cohort study, using the Washington State hospital discharge database for 89,405 adults aged 65 and older who underwent common abdominopelvic procedures (cholecystectomy, colectomy, hysterectomy/oophorectomy, and prostatectomy) between 1987 and 2004.
  
  
  METHODS
  Discharge location and short-term and long-term mortality.
  
  
  RESULTS
  Advancing age was associated with discharge to an institutional care facility (ICF) after surgery [age, 65-69 (3.3%); 70-74 (5.7%); 75-79 (10.8%); 80-84 (20.6%); 85-89 (31.8%); 90+ (43.9%); trend test, P < 0.001). Postoperative complications were also associated with discharge to an ICF (21.9% vs. 8.9%, P < 0.001). Patients discharged to an ICF after surgery had higher 30-day (4.3% vs. 0.4%), 90 day (12.6% vs. 1.4%), and 1-year mortality (22.2% vs. 5.9%) in comparison with those discharged home with self-care (P < 0.001). Compared with similarly aged adults discharged home, patients discharged to an ICF had 4 times higher 1-year mortality (odds ratio = 3.9; 95% confidence interval = 3.6-4.2). Of patients who died after discharge to an ICF, the majority died either at the ICF (53.7%) or on a subsequent hospital admission (31.0%).
  
  
  CONCLUSIONS
  Advancing age and postoperative complications are associated with the risk of discharge to an ICF after abdominopelvic operations. Patients discharged to an ICF are much more likely to die within the first postoperative year and ICF disposition should be considered as either a marker of debility and/or a component of patient decline. These findings may be helpful while counseling patients regarding the expected outcomes of ICF placement after surgical intervention.
authors.affiliation: Department of Medicine, University of Washington School of Medicine, Seattle, 98195-6410, USA.
authors.forename: Victor J
authors.initials: VJ
authors.lastname: Legner
authors.forename: Nader N
authors.initials: NN
authors.lastname: Massarweh
authors.forename: Rebecca G
authors.initials: RG
authors.lastname: Symons
authors.forename: Wayne C
authors.initials: WC
authors.lastname: McCormick
authors.forename: David R
authors.initials: DR
authors.lastname: Flum
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D006707:Homes for the Aged / Q000706:statistics & numerical data*; D006801:Humans; D009735:Nursing Homes / Q000706:statistics & numerical data*; D010351:Patient Discharge / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013514:Surgical Procedures, Operative / Q000401:mortality*