title: Which Patients Require More Care after Hospital Discharge? An Analysis of Post-Acute Care Use among Elderly Patients Undergoing Elective Surgery.
abstract: BACKGROUND
  The use of post-acute care is common among the elderly and accounts for $62 billion in annual Medicare expenditures. However, little is known about post-acute care use after surgery.
  
  
  METHODS
  Data were merged between the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) and Medicare claims for 2005 to 2008. Post-acute care use, including skilled nursing facilities (SNF), inpatient rehabilitation facilities (IRF), and home health care (HHC) were analyzed for 3 operations: colectomy, pancreatectomy, and open abdominal aortic aneurysm repair. Controlling for both preoperative risk factors and the occurrence of postoperative complications, we used multinomial logistic regression to estimate the odds of use for each type of post-acute care after elective surgery compared with home discharge.
  
  
  RESULTS
  Post-acute care was used frequently for patients undergoing colectomy (40.0%; total n=10,932), pancreatectomy (46.0%; total n=2,144), and open abdominal aortic aneurysm (AAA) repair (44.9%; total n=1,736). Home health was the most frequently reported post-acute care service for each operation (range 23.2% to 31.5%) followed by SNF (range 12.0% to 15.0%), and then by IRF (range 2.5% to 5.4%). The majority of patients with at least 1 inpatient complication were discharged to post-acute care (range 58.6% for open AAA repair to 64.4% for colectomy). In multivariable analysis, specific preoperative risk factors, including advanced age, poor functional status, and inpatient complications were significantly associated with increased risk-adjusted odds of discharge to post-acute care for each operation studied.
  
  
  CONCLUSIONS
  Among elderly patients, post-acute care use is frequent after surgery and is significantly associated with several preoperative risk factors and postoperative inpatient complications. Further work is needed to ensure that post-acute care services are used appropriately and cost-effectively.
authors: Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, CA; VA Greater Los Angeles Healthcare System, Los Angeles, CA. Electronic address: gsacks@mednet.ucla.edu.
authors: Greg D
authors: GD
authors: Sacks
authors: Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, CA.
authors: Elise H
authors: EH
authors: Lawson
authors: Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, CA; VA Greater Los Angeles Healthcare System, Los Angeles, CA.
authors: Aaron J
authors: AJ
authors: Dawes
authors: Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, CA; VA Greater Los Angeles Healthcare System, Los Angeles, CA.
authors: Melinda M
authors: MM
authors: Gibbons
authors: Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA.
authors: David S
authors: DS
authors: Zingmond
authors: Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, CA; Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA; VA Greater Los Angeles Healthcare System, Los Angeles, CA; Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, IL.
authors: Clifford Y
authors: CY
authors: Ko
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D017558:Elective Surgical Procedures; D005260:Female; D006699:Home Care Services / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D010351:Patient Discharge / Q000706:statistics & numerical data*; D011183:Postoperative Complications; D012047:Rehabilitation Centers / Q000706:statistics & numerical data*; D012307:Risk Factors; D012866:Skilled Nursing Facilities / Q000706:statistics & numerical data*; D014481:United States