title: Association Between Hospital Readmission and Acute and Sustained Delays in Functional Recovery During 18 Months After Elective Surgery: The Successful Aging after Elective Surgery Study.
abstract: To examine the effect of hospital readmission on functional recovery after elective surgery in older adults.
  
  
  
  Prospective cohort of individuals aged 70 and older undergoing elective surgery, enrolled from June 2010 to August 2013.
  
  
  
  Two academic medical centers.
  
  
  
  Community-dwelling older adults (N = 566; mean age ± standard deviation 77 ± 5) undergoing major elective surgery and expected to be admitted for at least 3 days.
  
  
  
  Readmission was assessed in multiple interviews with participants and family members over 18 months and validated against medical record review. Physical function was assessed according to ability to perform instrumental activities of daily living (IADLs) and activities of daily living (ADL), Medical Outcomes Study 12-item Short-Form Survey Physical Component Summary score, and a standardized functional composite.
  
  
  
  Two hundred fifty-five (45%) participants experienced 503 readmissions. Readmissions were associated with delays in functional recovery in all measures of physical function. Having two or more readmissions over 18 months was associated with persistent and significantly greater risk of IADL dependence (relative risk (RR) = 1.8, 95% confidence interval (CI) = 1.5-2.3) and ADL dependence (RR = 3.3, 95% CI = 1.7-6.4). Degree of functional impairment increased progressively with number of readmissions. Readmissions within 2 months resulted in delayed functional recovery to baseline by 18 months, and readmissions between 12 and 18 months after surgery resulted in loss of functional recovery previously achieved.
  
  
  
  Readmission after elective surgery may contribute to delays in functional recovery and persistent functional deficits in older adults.
authors.affiliation: School of Medicine, Yale University, New Haven, Connecticut.
authors.forename: Margaret A
authors.initials: MA
authors.lastname: Pisani
authors.affiliation: School of Medicine, Yale University, New Haven, Connecticut.
authors.forename: Asha
authors.initials: A
authors.lastname: Albuquerque
authors.affiliation: Harvard Medical School, Boston, Massachusetts.|Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
authors.forename: Edward R
authors.initials: ER
authors.lastname: Marcantonio
authors.affiliation: Departments of Psychiatry and Human Behavior, Brown University Warren Alpert Medical School, Providence, Rhode Island.|Department of Neurology, Brown University Warren Alpert Medical School, Providence, Rhode Island.
authors.forename: Richard N
authors.identifier: 0000-0002-1049-218X
authors.initials: RN
authors.lastname: Jones
authors.affiliation: Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts.
authors.forename: Ray Yun
authors.initials: RY
authors.lastname: Gou
authors.affiliation: Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts.|Harvard Medical School, Boston, Massachusetts.|Department of Neurology, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
authors.forename: Tamara G
authors.initials: TG
authors.lastname: Fong
authors.affiliation: Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts.
authors.forename: Eva M
authors.initials: EM
authors.lastname: Schmitt
authors.affiliation: Departments of Psychiatry and Human Behavior, Brown University Warren Alpert Medical School, Providence, Rhode Island.|Department of Neurology, Brown University Warren Alpert Medical School, Providence, Rhode Island.
authors.forename: Douglas
authors.initials: D
authors.lastname: Tommet
authors.affiliation: Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts.
authors.forename: Ilean I
authors.initials: II
authors.lastname: Isaza Aizpurua
authors.affiliation: Harvard Medical School, Boston, Massachusetts.|Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
authors.forename: David C
authors.initials: DC
authors.lastname: Alsop
authors.affiliation: Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts.|Harvard Medical School, Boston, Massachusetts.|Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
authors.forename: Sharon K
authors.initials: SK
authors.lastname: Inouye
authors.affiliation: Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts.|Harvard Medical School, Boston, Massachusetts.|Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
authors.forename: Thomas G
authors.initials: TG
authors.lastname: Travison
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000375:Aging; D015331:Cohort Studies; D004185:Disability Evaluation; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008404:Massachusetts; D010359:Patient Readmission / Q000706:statistics & numerical data*; D020127:Recovery of Function
keywords: aging; cohort study; physical function; readmission; surgery