Academic Journal
How skilled are skilled facilities? Post-discharge complications after colorectal cancer surgery in the U.S.
| Τίτλος: | How skilled are skilled facilities? Post-discharge complications after colorectal cancer surgery in the U.S. |
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| Συγγραφείς: | Abd El Aziz, M.A., Grass, F., Behm, K.T., D'Angelo, A.L., Mathis, K.L., Dozois, E.J., Larson, D.W. |
| Έτος έκδοσης: | 2021 |
| Συλλογή: | Université de Lausanne (UNIL): Serval - Serveur académique lausannois |
| Θεματικοί όροι: | Aftercare/statistics & numerical data, 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 |
| Περιγραφή: | 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 ... |
| Τύπος εγγράφου: | article in journal/newspaper |
| Περιγραφή αρχείου: | application/pdf |
| Γλώσσα: | English |
| ISSN: | 1879-1883 |
| Relation: | The American Journal of Surgery; https://iris.unil.ch/handle/iris/212061; serval:BIB_6E1F6FA8B627; 000663041700007 |
| DOI: | 10.1016/j.amjsurg.2020.12.012 |
| Διαθεσιμότητα: | https://iris.unil.ch/handle/iris/212061 https://doi.org/10.1016/j.amjsurg.2020.12.012 |
| Αριθμός Καταχώρησης: | edsbas.3386E2D5 |
| Βάση Δεδομένων: | BASE |
| ISSN: | 18791883 |
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| DOI: | 10.1016/j.amjsurg.2020.12.012 |