J. T. Killian1, M. C. Mason2, P. J. Richardson3, P. Kougias2,3, F. Bakaeen4, A. D. Naik3,5, D. H. Berger2,3, C. Balentine1,6, D. A. Anaya7 1University Of Alabama at Birmingham,Department Of Surgery,Birmingham, Alabama, USA 2Baylor College Of Medicine,Michael E. DeBakey Department Of Surgery,Houston, TX, USA 3Houston Veterans Affairs Health Services Research And Development Center For Innovations In Quality, Effectiveness And Safety (IQUEST),Houston, TX, USA 4Cleveland Clinic,Department Of Thoracic And Cardiovascular Surgery,Cleveland, OH, USA 5Baylor College Of Medicine,Alkek Department Of Medicine,Houston, TX, USA 6University Of Alabama at Birmingham,Institute For Cancer Outcomes & Survivorship,Birmingham, Alabama, USA 7Moffitt Cancer Center And Research Institute,Department Of Gastrointestinal Oncology,Tampa, FL, USA
Introduction: After complex surgery, patients are frequently discharged to post-acute care including skilled nursing facilities, inpatient rehabilitation, and long-term care. The purpose of this study was to describe survival after discharge to post-acute care in order to provide accurate information for informed consent and discussions with patients and their families prior to surgery.
Methods: We retrospectively examined 60,666 patients within the Veterans Affairs system who had colorectal surgery, hepatectomy, pancreatectomy, coronary artery bypass grafting, abdominal aortic aneurysm repair, and peripheral vascular bypass from 2008-2011. Patients were classified by their discharge destination to home or to post-acute care (skilled nursing facilities, rehabilitation, or long-term care). We calculated five-year overall survival using the methods of Kaplan and Meier.
Results: A total of 4,744 (8%) patients were discharged to post-acute care. Of these, 2,180 (46%) patients were 70 years of age or older and 98% were men. Median follow-up was 3.3 years. Overall survival at five years for all patients discharged to post-acute care was 50%. Five-year overall survival for each procedure included: coronary artery bypass grafting (63%), open abdominal aortic aneurysm repair (50%), peripheral vascular bypass (44%), colorectal resection (41%), endovascular abdominal aortic aneurysm repair (40%), pancreatectomy (35%), and hepatectomy (22%). Survival for the total cohort and for each procedure was significantly worse for patients discharged to post-acute care compared to those discharged home (p<0.05).
Conclusion: Discharge to post-acute care is associated with exceedingly poor survival following complex abdominal, cardiac, and vascular surgery. For high risk patients, this information should be clearly communicated to patients and their families prior to consenting for surgery and during discharge planning. Patients discharged to post-acute care also represent a highly vulnerable population that may benefit from preoperative and postoperative programs designed to enhance recovery from surgery.