A. N. Stumpf2, C. M. Papageorge2, G. D. Kennedy2 2University Of Wisconsin,Department Of Surgery,Madison, WI, USA
Introduction: Preoperatively anticipating the discharge destination of patients contributes to quality patient-doctor conversations regarding long term goals and quality of life. Additionally, previous literature has found that early identification of discharge destination may decrease the hospital length of stay and improve patient care planning. The purpose of this study was to identify preoperative predictors of discharge to higher level of care in patients undergoing colectomy.
Methods: Patients undergoing colectomy in 2012-2013 were identified in the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) targeted colectomy database. Exclusion criteria included death before discharge; discharge to a facility that was already home; unknown discharge destination; discharge to a separate acute care facility; outpatient surgery; and ASA Class 5 or unknown. Two cohorts were established based on discharge destination. One group included all patients discharged to home, while the other consisted of those discharged to an increased level of care (ILC), which was defined as a skilled or unskilled nursing facility or rehab that was not originally home. Univariate analysis was performed using Chi-squared tests for categorical variables and Student’s t-tests for continuous variables to identify patient characteristics, comorbidities, and operative factors associated with discharge to ILC. Variables with p-value <0.1 on univariate analysis were included in a multivariate model in order to identify the variables with the largest independent contribution to discharge destination.
Results: A total of 36,492 patients were included in this study, with a rate of discharge to ILC of 11.2% (n = 4111). The mean age of the ILC group was 73 years of age, compared to 60 years in those discharged to home (p=<0.001). On univariate analysis, the ILC group had a significantly higher incidence of emergent cases, renal failure, insulin-dependent diabetes, preoperative wound infection, and preoperative systemic sepsis. Multivariate analysis (Table 1) confirms a higher odds ratio of several comorbidities when controlling for cohort differences at baseline.
Conclusion: As expected, discharge to an ILC was associated with a more dependent functional status, preoperative ventilator-dependence, and higher ASA class. These findings may contribute to a more informed discussion of postoperative expectations and planning in patients being considered for colectomy.
