Unrealistic Postsurgical Expectation of Independence Predicts Complex Hospital Discharge.
Unrealistic Postsurgical Expectation of Independence Predicts Complex Hospital Discharge.
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对独立性的不切实际的术后期望预示着复杂的出院。
DOI：
10.1016/j.jss.2018.10.031
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发表时间：
2019
期刊：
影响因子：
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通讯作者：
Min,LillianC
中科院分区：
文献类型：
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作者：
Chan,Chiao-Li;Diehl,KathleenM;Hall,KarenE;Palazzolo,WilliamC;Pollock,YaoYao;Min,LillianC
背景谨慎的出院计划可以减少老年外科患者的住院时间、再入院时间和费用。材料和方法脆弱老年人手术路径和结果评估是一项简短的术前评估，可以确定具有多维老年风险的老年患者(年龄≥70岁)，由以下三项定义：(1)身体或认知障碍，(2)独居，和(3)缺乏无障碍的家。脆弱老年人手术路径和结果评估还提出了一个新的术后自我护理能力问题，即患者是否能够在出院后独立提供几个小时的自我护理。根据多维老年风险(完全无风险或部分老年风险)和自理能力问题(是或否)将患者分为四组，我们假设那些术后独立期望(UPSI)不切实际(完全处于风险和对自理能力问题为是)的患者将面临复杂出院计划的风险增加。复杂出院计划定义为因非医疗原因或多次改变出院计划而延长住院时间。结果在382例≥患者中，366例患者的自我护理问题无遗漏，其中5%的患者有不稳定性不适症状，6.3%的患者需要复杂的出院计划。与正常组相比，UPSI组发生复杂出院计划的风险更大(优势比=44.3[95%可信区间，1.1-16.1])。结论复杂出院是罕见的，但通过术前老年筛查可以预测。UPSI患者应在手术前有针对性地制定术后护理计划。
BackgroundCareful discharge planning for older surgical patients can reduce length of stay, readmission, and cost. We hypothesized that patients whooverestimatetheir self-care ability before surgery are more likely to have complex postoperative discharge planning.Materials and methodsThe Vulnerable Elders Surgical Pathways and Outcomes Assessment is a brief preoperative assessment that can identify older (age ≥70) patients with multidimensional geriatric risk, defined by all three of the following: (1) physical or cognitive impairment, (2) living alone, and (3) lack of handicap-accessible home. The Vulnerable Elders Surgical Pathways and Outcomes Assessment also asks a novel postoperative self-care ability question, whether patient can independently provide self-care for several hours after discharge. Classifying patients into four groups based on multidimensional geriatric risk (fullversusnone or partial) and the self-care ability question (yes or no), we hypothesized those withunrealistic postsurgical expectation of independence(UPSI) (both fully at risk and “yes” to self-care ability question) would be at the increased risk for complex discharge planning. Complex discharge planning was defined as prolonged stay because of nonmedical reasons or multiple changes in discharge plans.ResultsIn 382 hospitalizations of ≥2 d, 366 had a nonmissing answer to the self-care question; of those 5% had UPSI and 6.3% needed complex discharge planning. The UPSI group was independently associated with greater risk of complex discharge planning compared with the normal group (odds ratio = 4.3 [95% confidence interval, 1.1-16.1]).ConclusionsComplex discharges were rare, but predictable by preoperative geriatric screening. Patients with UPSI should be targeted for postoperative care planning in advance of surgery.