Postoperative Transitional Care Needs in the Elderly An Outcome of Recovery Associated With Worse Long-term Survival

作者：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^*

来源：Annals of Surgery, 2015, 261(4): 695-701.

DOI：10.1097/SLA.0000000000000673

• elderly
• postoperative
• surgery
• survival
• transitional care needs

Objective: To characterize transitional care needs (TCNs) after colorectal cancer (CRC) surgery and examine their association with age and impact on overall survival (OS).
Background: 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.
Methods: 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.
Results: TCNs were required by 130 patients (27%). The oldest patients had highest TCNs (49%) compared with the other age groups (P < 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 (P < 0.001).
Conclusions: 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.

• 出版日期2015-4