W. Rafaqat1, M. Abiad1, E. Lagazzi1, I. Nzenwa1, V. Panossian1, K. Ghaddar1, A. Hoekman1, S. Arnold1, M. P. DeWane1, H. M. Kaafarani1, G. C. Velmahos1, J. O. Hwabejire1 1Massachusetts General Hospital, Boston, MA, USA
Introduction: General Surgery procedures place significant physical and emotional stress on patients, especially geriatric patients. However, the impact of discharge to a skilled nursing facility (SNF) on patient recovery is not well-characterized. Therefore, we aimed to compare the impact of discharge to a SNF versus home on readmission rates.
Methods: We retrospectively reviewed the National Readmission Database (2016-2019) and included patients >65 years who underwent an elective or emergent general surgery procedure between January to September. We performed a 1:1 propensity-matched analysis adjusting for patient demographics, Hospital Frailty Score, procedure, and hospital complications. Our primary outcome was 30-day readmissions, and our secondary outcome was 30-day and 90-day mortality and 90-day readmissions. We performed a sensitivity analysis on patients undergoing emergency procedures.
Results: We included 140,056 patients of whom 33,916 (24.2%) were discharged to a SNF. Patients discharged to SNF were older (79 vs. 72 years; p<0.001), had a high Hospital Frailty Score (6.9% vs. 0.3%; p<0.001), and were more likely to be on Medicare insurance (93.6% vs. 88.4%; p<0.001). In the matched population of 19,763 pairs, 30-day and 90-day readmission and mortality were higher in patients discharged to a SNF (Table 1). The most common reason for readmission in the SNF group was gastric complications (46.0%) with intestinal obstruction being the most common diagnosis. In the sensitivity analysis among patients undergoing emergency procedures, patients discharged to SNF had significantly higher 30-day and 90-day readmission and mortality rates compared to patients discharged home.
Conclusion: Discharge to a SNF compared to patients discharged home is associated with a higher readmission and mortality rate in propensity-matched patients undergoing general surgery procedures. Future studies need to identify the patient and facility factors responsible for this disparity.
