Discharge disposition to skilled nursing facility after emergent general surgery predicts a poor prognosis

Anghela Z. Paredes, Azeem T. Malik, Marcus Cluse, Scott A. Strassels, Heena P. Santry, Daniel Eiferman, Christian Jones, Daniel Vazquez

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Emergency general surgery can have a profound impact on the functional status of even previously independent patients. The role and influence of discharging a patient to a skilled nursing facility, however, remains largely unknown. Methods: We queried the American College of Surgeons National Surgical Quality Improvement Program for community-dwelling adults who underwent 1 of 7 emergency general surgery procedures and were discharged home or to a skilled nursing facility from 2012 to 2016. Propensity score matching and multivariable regression analyses were performed to determine the relationship between discharge disposition and outcomes. Results: Overall, 140,922 patients met the inclusion criteria. The majority were discharged home (95.9%). After applying 1:1 propensity score matching, in comparison to patients discharged home, individuals discharged to a skilled nursing facility had a greater odds of respiratory (odds ratio 2.32; 95% confidence interval, 1.59–3.38) and septic complications (odds ratio 1.63, 95% confidence interval 1.12–2.36) after discharge. Furthermore, following surgery, individuals discharged to a skilled nursing facility had a greater odds of 30-day readmission (odds ratio 1.14; 95% confidence interval, 1.01–1.29), and death within 30 days of the procedure (odds ratio 2.07; 95% confidence interval, 1.65–2.61). Conclusion: After accounting for patient severity and perioperative course, discharge to a skilled nursing facility is an independent risk factor for death, readmission, and postdischarge complications.

Original languageEnglish (US)
Pages (from-to)489-495
Number of pages7
JournalSurgery (United States)
Volume166
Issue number4
DOIs
StatePublished - Oct 2019

ASJC Scopus subject areas

  • Surgery

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