Abstract
Background
Increased longevity has led to more nonagenarians undergoing elective surgery. Development
of predictive models for hospital readmission may identify patients who benefit from
preoperative optimization and postoperative transition of care intervention. Our goal
was to identify significant predictors of 30-d readmission in nonagenarians undergoing
elective surgery.
Methods
Nonagenarians undergoing elective surgery from January 2011 to December 2012 were
identified using the American College of Surgeons National Surgical Quality Improvement
Project participant use data files. This population was randomly divided into a 70%
derivation cohort for model development and 30% validation cohort. Using multivariate
step-down regression, predictive models were developed for 30-d readmission.
Results
Of 7092 nonagenarians undergoing elective surgery, 798 (11.3%) were readmitted within
30 d. Factors significant in univariate analysis were used to develop predictive models
for 30-d readmissions. Diabetes (odds ratio [OR]: 1.51, 95% confidence interval [CI]:
1.24-1.84), dialysis dependence (OR: 2.97, CI: 1.77-4.99), functional status (OR:
1.52, CI: 1.29-1.79), American Society of Anesthesiologists class II or higher (American
Society of Anesthesiologist physical status classification system; OR: 1.80, CI: 1.42-2.28),
operative time (OR: 1.05, CI: 1.02-1.08), myocardial infarction (OR: 5.17, CI: 3.38-7.90),
organ space surgical site infection (OR: 8.63, CI: 4.04-18.4), wound disruption (OR:
14.3, CI: 4.80-42.9), pneumonia (OR: 8.59, CI: 6.17-12.0), urinary tract infection
(OR: 3.88, CI: 3.02-4.99), stroke (OR: 6.37, CI: 3.47-11.7), deep venous thrombosis
(OR: 5.96, CI: 3.70-9.60), pulmonary embolism (OR: 20.3, CI: 9.7-42.5), and sepsis
(OR: 13.1, CI: 8.57-20.1), septic shock (OR: 43.8, CI: 18.2-105.0), were included
in the final model. This model had a c-statistic of 0.73, indicating a fair association
of predicted probabilities with observed outcomes. However, when applied to the validation
cohort, the c-statistic dropped to 0.69, and six variables lost significance.
Conclusions
A reliable predictive model for readmission in nonagenarians undergoing elective surgery
remains elusive. Investigation into other determinants of surgical outcomes, including
social factors and access to skilled home care, might improve model predictability,
identify areas for intervention to prevent readmission, and improve quality of care.
Keywords
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Article info
Publication history
Published online: February 23, 2017
Accepted:
February 16,
2017
Received in revised form:
January 5,
2017
Received:
August 29,
2016
Identification
Copyright
© 2017 Elsevier Inc. All rights reserved.
