How skilled are skilled facilities? Post-discharge complications after colorectal cancer surgery in the U.S.

Détails

Ressource 1Demande d'une copie Sous embargo indéterminé.
Accès restreint UNIL
Etat: Public
Version: Final published version
Licence: Non spécifiée
ID Serval
serval:BIB_6E1F6FA8B627
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Institution
Titre
How skilled are skilled facilities? Post-discharge complications after colorectal cancer surgery in the U.S.
Périodique
American journal of surgery
Auteur⸱e⸱s
Abd El Aziz M.A., Grass F., Behm K.T., D'Angelo A.L., Mathis K.L., Dozois E.J., Larson D.W.
ISSN
1879-1883 (Electronic)
ISSN-L
0002-9610
Statut éditorial
Publié
Date de publication
07/2021
Peer-reviewed
Oui
Volume
222
Numéro
1
Pages
20-26
Langue
anglais
Notes
Publication types: Journal Article
Publication Status: ppublish
Résumé
Characteristics and indications for discharging patients to home or a specific facility type have been studied; however, critical evaluation of these facilities through analysis of post-discharge complications and readmission rates is mandatory. The aim of this study was to compare complications occurring after discharge to home, skilled, and unskilled care facilities to identify potential pitfalls.
All adult (≥18 years) patients who underwent surgery for colon or rectal cancer from 2012 to 2017 as reported in the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database were included. Patients were categorized according to the discharge destination into: home, skilled care (rehabilitation center, separate acute care, skilled facility), and unskilled care (multilevel senior community, facility which is home, unskilled facility). Demographics, surgical risk factors and predischarge complications were compared between the three groups. Primary endpoints were overall, major, surgical, and medical complications occurring post-discharge, within 30 days of surgery. Further assessed were specific complications, readmission, length of stay, and 30-day mortality.
A total of 108,617 patients were identified. Of them, 100,478 (92%) discharged to home, 7313 (7%) to skilled, and 826 (1%) to unskilled care. Of patients discharged to skilled care, 1928 (26%) discharged to rehabilitation centers, 368 (5%) to separate acute care, and 5017 (69%) to skilled facilities. Adjusted overall, major, surgical, and medical post-discharge complications were highest among patients discharged to skilled care destinations. Subgroup analysis revealed separate acute care (inter-hospital transfer) to be associated with the highest morbidity. Main reasons for readmission were primarily related to surgical site infection and intestinal obstruction among the three main destinations, whereas readmissions for systemic sepsis and medical complications were more frequent in patients admitted to skilled care.
This study identified higher rates of post-discharge complications associated with skilled care destinations, despite risk adjustment. This over-morbidity is potentially related to prevailing medical complications and inter-hospital transfers. Further studies are needed to better understand those findings and to improve quality of post-acute care and related outcomes.
Mots-clé
Aftercare/statistics & numerical data, Aged, Aged, 80 and over, Colectomy/adverse effects, Colectomy/methods, Colorectal Neoplasms/surgery, Elective Surgical Procedures/adverse effects, Elective Surgical Procedures/methods, Female, Humans, Male, Middle Aged, Patient Discharge/statistics & numerical data, Patient Readmission/statistics & numerical data, Patient Transfer/methods, Patient Transfer/statistics & numerical data, Postoperative Complications/epidemiology, Postoperative Complications/etiology, Postoperative Complications/therapy, Proctectomy/adverse effects, Proctectomy/methods, Risk Factors, Skilled Nursing Facilities/statistics & numerical data, Subacute Care/statistics & numerical data, United States/epidemiology, Colorectal surgery, Discharge destination, Inter-hospital transfer, Skilled care, Unskilled care
Pubmed
Web of science
Open Access
Oui
Création de la notice
04/11/2021 14:14
Dernière modification de la notice
08/06/2023 5:55
Données d'usage