Postoperative Transitional Care Needs in the Elderly. Issue 4 (April 2015)

• Record Type: Journal Article
• Authors: Li, Linda T.; Barden, Gala M.; Balentine, Courtney J.; Orcutt, Sonia T.; Naik, Aanand D.; Artinyan, Avo; Sansgiry, Shubhada; Albo, Daniel; Berger, David H.; Anaya, Daniel A.
• Is Part Of: Annals of surgery. Volume 261:Issue 4(2015:Apr.)
• Publication Date: 2015-04
• Subjects: Surgery -- Periodicals; 617.005
• DOI: 10.1097/SLA.0000000000000673
• Languages: English
• ISSNs: 0003-4932

Abstract

<abstract> <title> <x xml:space="preserve">Abstract</x> </title> <sec> <title>Objective:</title> <p>To characterize transitional care needs (TCNs) after colorectal cancer (CRC) surgery and examine their association with age and impact on overall survival (OS).</p> </sec> <sec> <title>Background:</title> <p>TCNs after cancer surgery represent additional burden for patients and are associated with higher short-term mortality. They are not well-characterized in CRC patients, particularly in the context of a growing elderly population, and their effect on long-term survival is unknown.</p> </sec> <sec> <title>Methods:</title> <p>A retrospective cohort study of CRC patients (N = 486) having curative surgery at a tertiary referral center (2002–2011) was conducted. Outcomes included TCNs (home health or nonhome destination at discharge) and OS. Patients were compared on the basis of age: young (<65 years), old (65–74 years), and oldest (≥75 years). Multivariate logistic regression models were used to examine the association of age with TCNs, and OS was compared on the basis of TCNs and stage, using the Kaplan-Meier method.</p> </sec> <sec> <title>Results:</title> <p>TCNs were required by 130 patients (27%). The oldest patients had highest TCNs (49%) compared with the other age groups (<italic>P</italic> < 0.01), with rehabilitation services as their primary TCNs (80%). After multivariate analysis, patients 75 years or older had significantly increased TCN risk (odds ratio, 4.7; 95% confidence interval, 2.6–8.5). TCN was associated with worse OS for patients with early- and advanced stage CRC (<italic>P</italic> < 0.001).</p> </sec> <sec> <title>Conclusions:</title> <p>TCNs after CRC surgery are common and significantly increased in patients 75 years or older, represent an outcome of postoperative recovery, and are associated with worse long-term survival. Preoperative identification of higher risk populations should be used for patient counseling, advanced preoperative planning, and to implement strategies targeted at minimizing TCNs. </p> </sec> </abstract>