title: Preoperative impairment is associated with a higher postdischarge level of care.
abstract: BACKGROUND
  Although preoperative risk factors have been shown to lead to postdischarge institutionalization, an association between preoperative risk factors, preoperative level of required care, and discharge to higher levels of care has not previously been demonstrated.
  
  
  METHODS
  Using an institutional American College of Surgeons National Surgical Quality Improvement Program database, a retrospective review of elderly patients undergoing nonemergent inpatient general surgery procedures was performed with the goal of identifying preoperative risk factors that indicated the need for a higher level of care on hospital discharge. Univariate and multivariate analyses were performed on the patient population.
  
  
  RESULTS
  Over a 4-y period, 585 patients (29%) within the database were aged ≥65 y. In this population, 12% of patients required discharge to a higher level of care compared with their preoperative origin. In patients aged ≥65 y, impaired cognition, decreased functional capacity, advanced age (≥79 y), high American Society of Anesthesiologists class, and long hospital length of stay were found in univariate analysis to be associated with postoperative discharge to a higher level of care, although all of these variables except decreased functional capacity were also associated with a higher discharge level of care in multivariate analysis.
  
  
  CONCLUSIONS
  Cognitive and functional capacity scoring can be used as simple ways to indicate discharge to a higher level of care for older adults. Preoperative counseling in high-risk older adults needs to include the likelihood for discharge to a higher level of care, so that a possible referral to social work can be placed during discharge planning.
authors.affiliation: University of Wisconsin School of Medicine and Public Health, Madison, WI.
authors.forename: Colin C
authors.initials: CC
authors.lastname: Ehlenbach
authors.affiliation: Department of Surgery, University of Wisconsin, Madison, WI.
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Tevis
authors.affiliation: Department of Surgery, University of Wisconsin, Madison, WI.
authors.forename: Gregory D
authors.initials: GD
authors.lastname: Kennedy
authors.affiliation: Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX. Electronic address: sarah.oltmann@utsouthwestern.edu.
authors.forename: Sarah C
authors.initials: SC
authors.lastname: Oltmann
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D003072:Cognition Disorders / Q000453:epidemiology; D005260:Female; D013502:General Surgery / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D010348:Patient Care Team / Q000592:standards / Q000706:statistics & numerical data; D010351:Patient Discharge / Q000592:standards* / Q000706:statistics & numerical data*; D011182:Postoperative Care / Q000592:standards* / Q000706:statistics & numerical data*; D057234:Preoperative Period; D058996:Quality Improvement; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D012947:Social Work / Q000592:standards / Q000706:statistics & numerical data
keywords: Cognitive function; Discharge destination; Multidisciplinary team; Preoperative geriatric assessment; Surgical outcomes