A recent investigation by Yale University has uncovered that elderly Americans face a heightened likelihood of being readmitted to the hospital within 180 days following major surgery. This risk is particularly pronounced for those who are either frail or suffering from dementia. The research, published on February 28 in the journal JAMA Network Open, marks a significant advancement in understanding the postoperative challenges faced by the older population.
This study builds upon earlier work by the same Yale team, which established that major surgery is not uncommon among older Americans and highlighted an increased risk of mortality within one year post-surgery for individuals aged 65 and over. The current research is pioneering in examining this demographic’s immediate (within 30 days) and medium-term (within 180 days) hospital readmission risks. Analysing data from a nationally representative cohort of 1,477 older Americans who were not residing in nursing homes and underwent at least one major surgery between 2011 and 2018, the study found that more than a quarter (27.6%) were readmitted to the hospital within 180 days post-surgery, with nearly one in eight (11.6%) readmitted within just 30 days.
Dr. Robert D. Becher, associate professor of surgery at Yale School of Medicine and co-senior author, expressed concern over the previously unaddressed issue of longer-term readmissions post-major surgery among older individuals. He emphasised the significance of these findings for understanding the recovery process from major surgery in the older population. The study also highlights that the rates of readmission are alarmingly higher among patients with conditions commonly associated with geriatric patients, such as frailty and dementia, and those aged 90 and above, pointing towards the need for more targeted preoperative assessments and surgical planning.
Dr Thomas M. Gill, the Humana Foundation Professor of Geriatric Medicine at Yale and co-senior author of the study, stressed the critical role of recognising frailty and dementia before surgery in informing patients, families, and surgical decisions about the potential postoperative outcomes associated with these geriatric conditions.
The broader implications of hospital readmissions extend to the financial strain on the U.S. healthcare system, with costs exceeding $50 billion in 2018 alone. This is largely due to the 3.8 million cases of 30-day hospital readmissions, predominantly among Medicare beneficiaries aged 65 and older. Dr Becher pointed out the significant impact of hospital readmissions on the independence and functionality of older patients, underlining the importance of addressing this issue to preserve the quality of life for this vulnerable population.
The study represents a collaborative effort among the departments of Internal Medicine and Surgery at Yale School of Medicine and the Department of Biostatistics at Yale School of Public Health, highlighting the interdisciplinary approach required to tackle such complex health issues. Led by Yi Wang, a postdoctoral associate at Yale School of Medicine, with contributions from Linda Leo-Summers, Brent Vander Wyk, and Kendra Davis-Plourde, the research was conducted at the Yale Claude D. Pepper Older Americans Independence Center and received support from the National Institutes of Health grants.
The researchers are now focused on further exploring the causes behind the high hospital readmission rates among vulnerable older adults and devising effective strategies to reduce these risks. They aim to improve the postoperative outcomes for this growing population segment.
More information: Robert D. Becher, Thomas M. Gill et al, National Estimates of Short- and Longer-Term Hospital Readmissions After Major Surgery Among Community-Living Older Adults, JAMA Network Open. DOI: 10.1001/jamanetworkopen.2024.0028
Journal information: JAMA Network Open Provided by Yale University
