title: Postoperative transitional care needs in the elderly: an outcome of recovery associated with worse long-term survival.
abstract: OBJECTIVE
  To characterize transitional care needs (TCNs) after colorectal cancer (CRC) surgery and examine their association with age and impact on overall survival (OS).
  
  
  BACKGROUND
  TCNs after cancer surgery represent additional burden for patients and are associated with higher short-term mortality. They are not well-characterized in CRC patients, particularly in the context of a growing elderly population, and their effect on long-term survival is unknown.
  
  
  METHODS
  A retrospective cohort study of CRC patients (N = 486) having curative surgery at a tertiary referral center (2002-2011) was conducted. Outcomes included TCNs (home health or nonhome destination at discharge) and OS. Patients were compared on the basis of age: young (<65 years), old (65-74 years), and oldest (≥75 years). Multivariate logistic regression models were used to examine the association of age with TCNs, and OS was compared on the basis of TCNs and stage, using the Kaplan-Meier method.
  
  
  RESULTS
  TCNs were required by 130 patients (27%). The oldest patients had highest TCNs (49%) compared with the other age groups (P < 0.01), with rehabilitation services as their primary TCNs (80%). After multivariate analysis, patients 75 years or older had significantly increased TCN risk (odds ratio, 4.7; 95% confidence interval, 2.6-8.5). TCN was associated with worse OS for patients with early- and advanced stage CRC (P < 0.001).
  
  
  CONCLUSIONS
  TCNs after CRC surgery are common and significantly increased in patients 75 years or older, represent an outcome of postoperative recovery, and are associated with worse long-term survival. Preoperative identification of higher risk populations should be used for patient counseling, advanced preoperative planning, and to implement strategies targeted at minimizing TCNs.
authors.affiliation: *Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX †VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX ‡Department of Medicine, Baylor College of Medicine, Houston, TX §Operative Care Line, Michael E. DeBakey VA Medical Center, Houston, TX.
authors.forename: Linda T
authors.initials: LT
authors.lastname: Li
authors.forename: Gala M
authors.initials: GM
authors.lastname: Barden
authors.forename: Courtney J
authors.initials: CJ
authors.lastname: Balentine
authors.forename: Sonia T
authors.initials: ST
authors.lastname: Orcutt
authors.forename: Aanand D
authors.initials: AD
authors.lastname: Naik
authors.forename: Avo
authors.initials: A
authors.lastname: Artinyan
authors.forename: Shubhada
authors.initials: S
authors.lastname: Sansgiry
authors.forename: Daniel
authors.initials: D
authors.lastname: Albo
authors.forename: David H
authors.initials: DH
authors.lastname: Berger
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Anaya
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D015179:Colorectal Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D003266:Continuity of Patient Care / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D016017:Odds Ratio; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D011182:Postoperative Care / Q000401:mortality*; D012044:Regression Analysis; D012189:Retrospective Studies; D016019:Survival Analysis