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Multi-institutional Cohort Study of Elective Diverticulitis Surgery: a National Surgical Quality Improvement Program Database Analysis to Identify Predictors of Non-home Discharge Among Older Adults

  • Original Article
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Journal of Gastrointestinal Surgery

Abstract

Background

Older adults often prioritize independence and time spent at home when making major treatment decisions. Identifying preoperative predictors of non-home discharge (i.e., requiring institutional discharge rather than home), among adults undergoing elective diverticulitis surgery, can support surgical decision-making and expectation management. This study aims to (1) examine rates of non-home discharge after elective surgery for diverticulitis and (2) identify predictors of non-home discharge.

Methods

This is a multi-institutional cohort study of National Surgical Quality Improvement Program Database. Patients over 18 years who underwent colon resection with diagnosis of diverticulitis were included. Clinical and demographic information were collected by trained nurse reviewers. Emergency operations were excluded. Patients with home versus non-home discharge were compared and predictors identified using multivariable regression.

Results

Between 2016 and 2019, 40,912 patients were identified. Mean age was 58.5 years (SD = 12.58) with 48.5% 60 + years and 17.7% of patients 70 + years old. The majority (55.9%) were female and “White” race (83.5%). Most patients underwent colectomy without ostomy (88.4%). Nine percent of patients over age 60 had non-home discharge. Functional dependence preoperatively was strongly associated with non-home discharge. On multivariable analysis, significant predictors of non-home discharge were preoperative functional dependence (OR 28.2; 95% CI 9.8–81.7), advancing chronologic age (age 80 + : OR 22.4; 95% CI 18.6–26.9), and preoperative albumin < 3.0 (OR 4.0; 95% CI 3.4–4.6).

Conclusions

Nearly one in ten patients over 60 years was not discharged home after elective diverticulitis surgery. Preoperative functional status predicts non-home discharge. Future studies need to assess potentially modifiable causes of non-home discharge, such as social support.

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Acknowledgements

The American College of Surgeons National Surgical Quality Improvement Program and the hospitals participating in the ACS NSQIP are the source of the data used herein; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors.

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CC, DC, SL, MB, ZC, and CR all made substantial contributions to conception and design of the work and interpretation of data, drafted the work critically for important intellectual content, approved the version to be published, and agreed to be accountable for all aspects of the work regarding accuracy or integrity.

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Correspondence to Christy E. Cauley.

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Appendix

Appendix

Table 4 Procedure and diagnosis codes

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Cauley, C.E., Chang, D.C., Lipsitz, S.R. et al. Multi-institutional Cohort Study of Elective Diverticulitis Surgery: a National Surgical Quality Improvement Program Database Analysis to Identify Predictors of Non-home Discharge Among Older Adults. J Gastrointest Surg 26, 1899–1908 (2022). https://doi.org/10.1007/s11605-022-05335-8

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