Discharge Destination Following Emergent Major Colectomy: An Analysis of Preoperative and Intraoperative Predictive Factors
Mehida Rojas-Alexandre, *David A Mahvi, *Pamela Lu, *Richard Urman, *Jason S. Gold, Edward E. Whang
Brigham & Women's Hospital, Boston, MA
Objective: To identify preoperative and intraoperative factors associated with increased risk for non-home discharge destination after elective major colectomy.
Design: Major colectomies were identified in the NSQIP Targeted Colectomy Dataset (years 2012 through 2017) defined by CPT code. Univariate and multivariate logistic regression analyses were performed for all preoperative and intraoperative variables (after multiple imputation to account for missing variables) to identify predictors of non-home discharge destination.
Setting: None
Patients: Patients with unknown discharge destination or who expired during initial hospitalization were excluded, leaving 22,668 patients for analysis
Interventions: None
Main Outcome Measures: Home vs. non-home discharge after major colectomies
Results: Overall, 7072 (31.2%) patients were discharged to rehab, skilled care, or acute care facilities. Preoperative factors associated with non-home discharge on multivariate analysis included female gender, older age, non-independent functional status, COPD, preoperative sepsis, elevated creatinine, and hypoalbuminemia (all p<0.001). Intraoperative factors significantly predictive of discharge destination on multivariate analysis included dirty or infected would classification, open surgery, and concurrent colostomy or cholecystectomy (all p<0.05). Patients discharged non-home had longer initial lengths of stay (19.5 vs. 11.0 days, p<0.001), higher readmission rates (14.0% vs. 12.1%, p<0.001), and higher reoperation rates (14.6% vs. 5.8%, p<0.001).
Conclusions: Several preoperative and intraoperative factors are associated with increased risk for non-home discharge after major colectomy. These data can aid in patient counseling and facilitate postoperative disposition planning.
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