Time Spent Away from Home in the Year Following High‐Risk Cancer Surgery in Older Adults

• Published in: Journal of the American Geriatrics Society (JAGS) Vol. 68; no. 3; pp. 505 - 510
• Main Authors: Suskind, Anne M., Zhao, Shoujun, Boscardin, W. John, Smith, Alexander, Finlayson, Emily
• Format: Journal Article
• Language: English
• Published: Hoboken, USA John Wiley & Sons, Inc 01.03.2020; Wiley Subscription Services, Inc
• Subjects: Aged; Aged, 80 and over; Cancer; Cancer surgery; cystectomy; Decision making; Esophagectomy; Female; Gastrectomy; Hospitalization - statistics & numerical data; Humans; Independent Living - statistics & numerical data; Insurance Claim Review - statistics & numerical data; Length of Stay - statistics & numerical data; Male; Medicare; Neoplasms - surgery; Nursing homes; Older people; Pancreaticoduodenectomy; Retrospective Studies; Skilled Nursing Facilities - statistics & numerical data; Surgery; Time Factors; United States; United States; cystectomy; esophagectomy; gastrectomy; Medicare; pancreaticoduodenectomy
• ISSN: 0002-8614; 1532-5415
• DOI: 10.1111/jgs.16344

OBJECTIVES To understand where older adults spend time (at home, in the hospital, or in a nursing home) in the year following high‐risk cancer surgery. DESIGN Retrospective cohort study. SETTING Medicare beneficiaries using data from Medicare Inpatient claims to ascertain hospital days and the Minimum Data Set to ascertain nursing home days. PARTICIPANTS Beneficiaries who underwent high‐risk cancer surgery (cystectomy, pancreaticoduodenectomy, gastrectomy, or esophagectomy) were identified to determine cumulative time spent away from home in the year following surgery. MEASUREMENTS Adjusted percentages of time spent away from home (ie, days in a hospital or nursing home) were modeled for the year following surgery. RESULTS A total of 37 748 beneficiaries underwent high‐risk cancer surgery during the study period, and 28.3% died within 1 year. Overall, beneficiaries spent 13.9 ± 26.2 days in the hospital (over 1.5 ± 2.0 hospital readmissions) and 37.2 ± 50.6 days in the nursing home (over 1.5 ± 1.0 admissions) in the year following surgery. Among beneficiaries who were alive and dead at 1 year, 18.5% and 30.1% of time was spent away from home, respectively. Beneficiaries who were initially discharged to a facility following surgery and died within 1 year spent 44.4% of their final year away from home. CONCLUSION Time spent away from home in the hospital and/or nursing home in the year following high‐risk cancer surgery is substantial among Medicare beneficiaries. This information is crucial in counseling patients on postoperative expectations and may additionally influence preoperative decision making. J Am Geriatr Soc 68:505–510, 2020