K. C. Lee1,2, D. Sturgeon1, S. Mitchell4,5, A. Salim1,3, Z. Cooper1,3,4 1Brigham And Women’s Hospital,Center For Surgery And Public Health,Boston, MA, USA 2University of California, San Diego,Department Of Surgery,La Jolla, CA, USA 3Brigham And Women’s Hospital,Division Trauma, Burns, And Critical Care,Boston, MA, USA 4Hebrew Senior Life Institute for Aging Research,Boston, MASSACHUSETTS, USA 5Beth Israel Deaconess Medical Center,Department Of Medicine,Boston, MA, USA
Introduction: Although 40% of emergency general surgery (EGS) procedures are performed in older adults, long-term outcomes remain understudied in this population. Furthermore, few studies have contextualized outcomes after EGS with acute hospitalizations for other common, high-risk medical conditions that have been targets for national quality improvement, such as pneumonia (PNA), acute myocardial infarction (AMI), or congestive heart failure (CHF). We hypothesized that older EGS patients have similar one-year survival and healthcare utilization compared to matched patients with an acute medical admission.
Methods: Patients 65 years or older were identified from 100% fee-for-service Medicare claims data from January 1, 2008 to December 31, 2014. EGS patients received one of the five highest-burden EGS procedures (partial colectomy, small-bowel resection, peptic ulcer disease surgery, lysis of adhesions, laparotomy). Medical patients were emergently admitted for PNA, AMI, or CHF. Patients were propensity-score matched based on age, gender, race/ethnicity, Medicare region, Charlson score, frailty index, hospital bed size, teaching hospital status, year of admission, and intensive care unit (ICU) stay. Bivariate analysis and a Cox regression model accounting for competing risk of death, hospital-level clustering, and follow-up time were performed to compare one-year mortality and healthcare utilization (rehospitalization, emergency department [ED] visit, and ICU stay) between the two groups.
Results: Propensity matches were obtained for 471,429 pairs. EGS patients and medical patients had an in-hospital mortality of 9.5% and 5.5% respectively, and experienced similar one-year mortality (adjusted hazard ratio [95% CI]: 0.96 [0.95-0.97]). In bivariate analysis, EGS patients had lower rates of ED visit (56.4% vs 64.6%, p<0.0001), re-hospitalization (26.1% v. 30.3%, p<0.0001), and ICU stay (21.7% vs 31.0%, p<0.0001) in the year after discharge compared to medical patients. After Cox regression, EGS patients had a lower hazard of healthcare utilization in the year after discharge compared to medical patients (Table).
Conclusion: Older EGS patients experience comparable one-year mortality to patients with acute medical admissions. Although hospital use after discharge is less likely when compared to medical patients, over 50% of EGS patients experience an ED visit and over 25% are re-hospitalized in the year after discharge. As such, EGS quality improvement programs are also needed to reduce healthcare utilization, identify targets for resource allocation, and improve outcomes among older patients.
