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LOI After Surgery Linked to Readmissions

Analysis  |  By Tinker Ready  
   July 21, 2016

Loss of independence after surgery affects a patient's functional status, mobility, and care needs and occurs frequently, especially in older patients, researchers determine.

What can hospitals learn from patients about how to prevent readmissions? One group of researchers decided to find out, and their results offer insights that may benefit patients, providers, and payers.

Older patients who report a loss of independence after surgery are more likely to die or be readmitted within 30 days, according to findings published in JAMA Surgery.  The research is based on data collected from more than 5,000 patients on post-surgery function, cognition, mobility, and decision-making.

The researchers report that "loss of independence," or LOI, occurred frequently and was more common in older patients.

After adjusting for risk, researchers concluded that LOI was associated with a 1.7-fold increased risk for readmission and a roughly 6.7-fold increased risk for death after discharge.

The findings suggest that efforts to preserve mobility and recruit social support services could help keep even frail patients from declining after surgery, says lead author Julia R. Berian, MD, a clinical researcher with the American College of Surgeons.

The study describes LOI as a "patient-centered outcome," as opposed to more common outcome measures such as readmissions.  That's because most patients don't measure the success of their care by the fact that they were not readmitted, Berian says.  

"I'm trying to couch our study in terms that matter to most patients—their living situations," she said. "Their ability to live independently – that is extremely important to some of them."

Mobility, Function, Cognition Undervalued

And while LOI might seem like an unavoidable outcome for complex patients, that is often not the case, Berian says.

Providers think "they were sick to begin with, or were likely to have a problem from the get-go, so there is likely nothing that I could have done," she said. "But, I think we undervalue mobility and function and cognition."

While these factors can be difficult to measure, Berian says, they can often be addressed with simple efforts such as making sure patients are walked down the hall during recovery to improve mobility.

The researchers used an ACS clinical registry with data from 26 hospitals. Loss of independence was defined as a decline in one or all of three areas: functional status, mobility, and care needs.

They compared patient capacity for bathing, dressing, grooming, eating, and using the toilet before and after surgery. The defined care needs based on discharge destination and the need for support in the home.

Loss of independence was found to increase with age, ranging from 50% of patients 65 to 74 years old and 84% of patients older than 85. After post-surgical complications, LOI was the biggest factor in readmissions.

Researchers also found that LOI was strongly associated with mortality, along with other factors including emergency operations and age.

And while hospital physical therapy programs can help, in some cases, simply having a geriatrician or hospitalist involved with surgical patients is enough to improve LOI.

These clinicians can to make sure that patients are getting out of bed regularly and can talk with patients about the impact of their surgery on non-medical aspects of their lives, Berian says.  

"We have traditionally counseled people with the model, 'You have a problem, we are going to fix it, and you are going to back to your normal life,'" she says.

"One of the factors patient often care about but isn't discussed, she says, is what is a patient's life "going to look like after surgery?"

Tinker Ready is a contributing writer at HealthLeaders Media.

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