J. K. Johnson1, R. L. Marcus1, G. J. Stoddard3, J. M. Fritz1, C. S. Noren4, B. S. Brooke2 1University Of Utah,Physical Therapy,Salt Lake City, UT, USA 2University Of Utah,Surgery,Salt Lake City, UT, USA 3University Of Utah,Internal Medicine,Salt Lake City, UT, USA 4University Of Utah,Rehabilitation Services,Salt Lake City, UT, USA
Introduction: While an association between patients’ functional status and 30-day hospital readmission has been demonstrated in recent studies, the optimal tool to measure functional status during the post-operative period remains unclear. One potential tool is the Activity Measure for Post-Acute Care “6-Clicks” Basic Mobility Short Form (AM-PAC), which can be integrated into an electronic medical record and completed by providers in less than one minute. This study was designed to evaluate the utility of the AM-PAC for assessing post-operative functional status and its ability to predict risk for 30-day hospital readmission following major surgery.
Methods: We identified all patients at a single academic hospital who underwent a major cardiothoracic, vascular, or general surgery procedure between August 2014 and July 2016 and underwent assessment of post-operative functional status using the AM-PAC. Patient mobility at the time of hospital discharge was categorized by tertile of AM-PAC scores into high, low and very low. The association between mobility tertiles and readmission risk was assessed using mixed effects Poisson regression models that controlled for patient-level confounders.
Results: Among 2,105 patients who underwent major surgery during the time period [640 (30%) cardiothoracic, 383 (18%) vascular, and 1,082 (52%) general surgery procedures], a total of 1,001 (48%) patients were assessed with AM-PAC at discharge. The overall 30-day readmission rate was 14.9%, and was significantly higher among patients in the lowest tertile of AM-PAC scores (22.6% low vs. 12.5% high; P=0.003). Among all surgical patients, individuals with very low mobility at the time of hospital discharge had a significantly higher risk for readmission (aRR:1.57; 95%CI, 1.05-2.35) compared to patients with high mobility. This effect was found across different surgical specialties, including patients undergoing cardiothoracic (aRR:2.00; 95%CI, 1.02-3.93) and vascular (aRR:2.99; 95%CI, 0.98-9.12) surgery procedures, but was not significant for patients undergoing general (aRR:1.04; 95%CI, 0.58-1.87) surgeries (Figure).
Conclusion: Post-operative mobility can be easily assessed using the AM-PAC tool and used to predict 30-day readmission for diverse cohorts of surgical patients. Recognition of poor functional status in surgical patients prior to discharge can help identify the need for additional targeted physical therapist interventions and enhanced discharge planning as a strategy to reduce hospital readmissions.
