Seniors Have Increased Hospital Readmission Risk Within 180 Days of Major Surgery

Robert D. Becher, MD, MS, FACS

Credit: Yale School of Medicine

Older adults, especially those who are frail or have dementia, have an increased risk for hospital readmission within 180 days of undergoing major surgery, Yale investigators found.¹

The same Yale team found older Americans aged ≥ 65 years have a greater mortality risk within 1 year of major surgery.² The new study focused on both short-term risk (within 30 days) and longer-term risk (within 180 days) of hospital readmissions for older adults who had major surgery.

“Prior to now, data on longer-term readmissions after major surgery in older persons have been lacking,” said investigator Robert D. Becher, MD, MS, FACS, associate professor of surgery at Yale School of Medicine, in a press release. “This is problematic, as older persons undergoing major surgery represent a large and growing population.”

Hospital readmissions are a financial burden. In 2018, the nearly 3.8 million 30-day hospital readmissions cost ≥ $50 billion. Most of the participants were Medicare beneficiaries aged ≥ 65 years. Not only are hospital readmissions costly, but they can interfere with an older adult’s maintaining independence and function.

Investigators, led by Yi Wang, PhD, conducted a prospective longitudinal cohort study of National Health and Aging Trends study data (2011 – 2018) linked to data from the Centers for Medicare & Medicaid Services.¹ They sought to evaluate estimates of hospital readmission within 30 – 180 days after major surgery and to see if estimates differed based on key demographic, surgical, and geriatric characteristics.

Participants (n = 1477) were community-living—thus not living in nursing homes—US residents aged ≥ 65 years old (mean age: 79.5 years) who had ≥ 1 major surgery from 2011 – 2018. Approximately half (56%) of the sample was female, 75% were non-Hispanic White, 49.8% had a high school education or less, 69% had fee-for-service Medicare coverage, and 15.5% were eligible for Medicaid.

Investigators identified a total of 1780 major operations—characterizing them as either musculoskeletal, abdominal, vascular, neurologic, cardiothoracic, and other which includes major endocrine, gynecologic, urologic, breast, plastic, and otolaryngologic. The team analyzed the data from April 10 – August 28, 2023.

Wang and colleagues found more than 1 in 4 (27.6%) had a hospital readmission within 180 days after a majority surgery (95% confidence interval [CI], 24.7% - 30.7%), and nearly 1 in 8 (11.6%) had a hospital readmission within only 30 days (95% CI, 9.8% - 13.6%).

“These readmission rates are high,” Becher said.² “This study adds to our understanding of what it means to recover from major surgery as an older person.”

Within 180 days, they found greater readmission rates for older adults who are ≥ 90 years old (45.8%; 95% CI, 37.7% - 54.1%), have dementia (39%; 95% CI, 30.7% - 47.1%), are frail (36.9%; 95% CI, 30.8% - 43.5%), and who are undergoing vascular surgery (36.8%; 95% CI, 28.3% - 46.3%).¹

“These findings [reinforce] the importance of enhanced preoperative recognition of frailty and dementia in older persons and may inform patient and family expectations — and surgical decision making — about postoperative trajectories in the setting of these geriatric conditions,” said investigator Thomas M. Gill, the Humana Foundation professor of geriatric medicine, in a press release.²

Age-and-sex-adjusted models with death as an additional risk, the hospital readmission risk within 180 days was 2.29 (95% CI, 1.70 – 3.09) for frailty and 1.58 (95% CI, 1.15 – 2.18) for likely dementia.¹

Investigators highlight limitations, such as no available data on the reasons for the surgery, postoperative complications, and operations after 2018. Additionally, data only came from the 48 attached US states, leaving out hospital readmission rates in the states of Alaska, Hawaii, and Puerto Rico.

“Taken together, our findings suggest that the occurrence of hospital readmissions within 180 days after major surgery varies substantially across distinct subgroups of older persons and underscores the potential value of geriatric conditions such as frailty and dementia in identifying increased risk,” investigators wrote.

^References

1. ^{Wang Y, Leo-Summers L, Vander Wyk B, Davis-Plourde K, Gill TM, Becher RD. National Estimates of Short- and Longer-Term Hospital Readmissions After Major Surgery Among Community-Living Older Adults. JAMA Netw Open. 2024;7(2):e240028. Published 2024 Feb 5. doi:10.1001/jamanetworkopen.2024.0028}
2. ^{Risk of Hospital Readmission After Surgery Is High for Older Americans. News Wise. February 28, 2024. https://www.newswise.com/articles/risk-of-hospital-readmission-after-surgery-is-high-for-older-americans. Accessed March 1, 2024.}