According to a study in the August issue of the Journal of the American Geriatrics Society, older adults are at greater risk of unanticipated hospital admission within 30 days of ambulatory surgery, even after adjusting for comorbidities. Diabetes mellitus, current cancer treatment, history of amputation or revascularization, renal failure, and chronic obstructive pulmonary disease also were linked with greater likelihood of hospital admission. (Access the study at http://bit.ly/1McrKur.)
The information was obtained for 2012 from the American College of Surgeons (ACS) National Surgical Quality Improvement Project (NSQIP) database. This database extracts information from more than 400 community and academic hospitals. Data are collected for acute care hospitals and freestanding surgery centers.
Data were collected in eight-day cycles, and the first 40 procedures in the cycle were included in the data set. The most commonly performed procedures were capped at five within each cycle to increase procedure heterogeneity.
The study indicated that medical complications included bleeding requiring a transfusion, pneumonia, unplanned intubation, urinary tract infection, pulmonary embolism, failure to wean from a ventilator, renal insufficiency, progressive renal failure, stroke, coma, peripheral neurological deficiency, cardiac arrest, myocardial infarction, deep venous thrombosis, and sepsis or septic shock.
The most frequently cited causes of hospital admission within 30 days of ambulatory surgery were wound problems (13.1%), followed by infections, bleeding, and pain (all near 5%). “It is likely that mitigation of these reasons will lead to a better understanding of warning signs, postoperative care instructions, and proper use of discharge medications,” the study said.
The study points out that it’s common for older adults to have cognitive impairment after surgery. “It is possible that poor cognitive function leads to poor self-care after ambulatory surgery, as higher admission rates in individuals with no surgical complication but with certain medical comorbidities revealed,” the study said.
Seniors are expected to care for themselves two to three hours after surgery, regardless of their health literacy, cognition, or home support, the study said.
“The current findings suggest that a more careful assessment of older adults at discharge after ambulatory surgery is warranted,” it says. “Older age may be a surrogate for poor health literacy and poor cognition, and measurement of health literacy and cognition at discharge would significantly improve the ability to detect which older adults are at the greatest risk of poor postsurgical outcomes.”
The exchange of post-discharge care instructions between providers and patients needs to be better and use more innovative methods, including specific targeted teaching, the authors suggest.
“Modifications of the current ambulatory surgery discharge criteria (physiology based) to a new paradigm that addresses the specific needs of older adults with poor health literacy have the potential to improve quality of care and safety of older adults undergoing ambulatory surgery,” they say.
