C. Balentine1,2,3, F. G. Bakaeen1,2, P. Kougias1,2, A. Naik2, P. J. Richardson2, D. H. Berger1,2, D. A. Anaya1,2 1Baylor College Of Medicine,Michael E DeBakey Department Of Surgery,Houston, TX, USA 2Michael E. DeBakey Veterans Affairs Medical Center,Houston, TX, USA 3University Of Wisconsin,Department Of Surgery,Madison, WI, USA
Introduction:
Recovery from major surgery is a complex process that frequently requires ongoing care as patients transition from acute care hospitals to home. This transitional care (TC) can involve time in rehabilitation hospitals, skilled nursing facilities or long term care hospitals designed to help regain functional independence. While there is considerable information on the need for TC following medical conditions such as heart failure and chronic lung disease, there is little data on the need for TC after surgery. The purpose of this study is to determine the overall need for TC following complex general, cardiac and vascular surgery.
Methods:
A retrospective cohort study using VA administrative data from 2006-2010 evaluating all patients undergoing colorectal resection, pancreaticoduodenectomy, liver resection, coronary artery bypass, and abdominal aortic aneurysm repair. was performed. Patients were categorized as needing TC if their discharge destination was being other than a home discharge. Chi-square was used to compare rates of TC use.
Results:
We found that TC needs were common among all of the operations assessed. Pancreaticoduodenectomy had the greatest overall proportion of TC utilization as 119 of 1,064 patients (11%) needed TC after discharge. TC use was higher during 2006-2008 (11.6-15.5%) compared to the final two study years (8-8.4%) though this difference was not statistically significant. Colorectal (1,850 patients out of 20,449, 9%) and coronary bypass (2,047 patients out of 23,658, 8.7%) operations required TC at similar rates and there was minimal variation in TC usage during the study period. A total of 54 out of 761 individuals having liver resections needed TC at discharge and this rate steadily declined from 12% in 2006 to 4% in 2010 (p<0.07). Finally, open and endovascular aneurysm repair had the lowest rates of TC as only 325 of 7,409 patients (4.4%) required TC, and these rates did not fluctuate significantly during the study period.
Conclusion:
Following complex surgery, a significant proportion of patients will require additional assistance in the form of TC as they attempt to recover their preoperative functional status. While the rate of TC utilization for liver resections seems to be declining over time, the other complex operations studied showed remarkably consistent rates of TC use from year to year. Further studies are needed to identify underlying reasons for TC use.