C. Balentine1,2, G. Leverson3, D. J. Vanness3, S. J. Knight4, J. Turan5, C. J. Brown6,7, G. D. Kennedy1, H. Chen1, S. Bhatia2 1University Of Alabama At Birmingham,Surgery,Birmingham, AL, USA 2University Of Alabama At Birmingham,Institute For Cancer Outcomes And Survivorship,Birmingham, AL, USA 3University Of Wisconsin,Wisconsin Surgical Outcomes Research,Madison, WI, USA 4University Of Alabama At Birmingham,Department Of Preventive Medicine,Birmingham, AL, USA 5University Of Alabama At Birmingham,School Of Public Health,Birmingham, AL, USA 6University Of Alabama At Birmingham,Birmingham/Atlanta VA GRECC,Birmingham, AL, USA 7University Of Alabama At Birmingham,Department Of Medicine, Division Of Gerontology, Geriatrics & Palliative Care,Birmingham, AL, USA
Introduction: Post-acute care services such as home health, skilled nursing facilities, and inpatient rehabilitation play an important role in postoperative recovery. Recent studies have questioned our ability to identify which setting best addresses each patient’s needs. The purpose of this study is to evaluate whether patients discharged to skilled nursing facilities or inpatient rehabilitation could also be candidates for home health referral and vice versa, and to calculate potential savings from greater utilization of home health. We hypothesized that a significant number of patients discharged to skilled nursing or rehabilitation would be similar to patients sent home with home health.
Methods: We analyzed 54,015 patients who were discharged with post-acute care after colectomy, pancreatectomy or hepatectomy from 2008-2011 in the Nationwide Inpatient Sample. The primary endpoint was the proportion of patients discharged to skilled nursing facilities or inpatient rehabilitation who had an equivalent patient discharged home with home health. This was determined by propensity score matching based on demographics, co-morbidity, postoperative complications, length of stay, predicted mortality, and insurance. A secondary outcome was potential cost savings based on average Medicare costs.
Results: A total of 30,843 patients were discharged home with home health and 23,172 were discharged to skilled nursing facilities or inpatient rehabilitation. 66% of patients discharged home with home health were ≥60 years old, compared to 90 % of the skilled nursing/rehabilitation group (p<0.001) and 70% of both groups were white. 14,163 (61%) patients discharged to skilled nursing or inpatient rehabilitation could be matched to an equivalent patient discharged home with home health. The matched populations did not show any differences in age, race, gender, insurance status, co-morbidity, postoperative complications, length of hospital stay, or predicted mortality (standardized difference <10%). Potential cost savings from treating at home rather than in skilled nursing or inpatient rehabilitation facilities ranged from $2.5 million to $438 million annually. Potential savings varied based on a two-way sensitivity analysis varying the percentage of the 14,163 patients treated at home and estimated cost differences between home health and skilled nursing or inpatient rehabilitation.
Conclusion: Many gastrointestinal surgery patients discharged to skilled nursing facilities and inpatient rehabilitation are similar to patients treated at home with home health. This may indicate the potential for significant cost savings by increasing use of home health, but it is also possible that patients sent home with home health might have benefited from discharge to skilled nursing facilities or rehabilitation. There is an urgent need for evidence-based guidelines to help surgeons match patient needs to post-acute care setting after surgery.