Healthy Days at Home after Emergency General Surgery: Shifting Towards Long-Term Patient-Centered Outcomes for Older Adults

BACKGROUND: Emergency general surgery (EGS) in older adults is commonly evaluated with short-term outcomes that may not reflect functional recovery. Healthy days at home (HDAH) captures time alive and living outside institutional care and may better reflect patient-centered recovery after EGS. STUDY DESIGN: We performed a retrospective cohort study using 2017 100% Medicare fee-for-service claims with 1-year look-back and follow-up. Community-dwelling adults aged >=66 years who underwent one of 7 EGS procedures within 48 hours of urgent/emergent admission were identified and stratified as low-risk (appendectomy, cholecystectomy) or high-risk (laparotomy, colectomy, small bowel resection, peptic ulcer repair, lysis of adhesions). HDAH were calculated from surgery through 365 days, subtracting days spent dead, hospitalized, in the emergency department, rehabilitation/nursing home, home health care, or hospice. Multivariable linear regression identified factors associated with HDAH overall and by procedural risk. RESULTS: Among 29,828 older adults, 32.95% underwent a high-risk procedure. Mean HDAH was lower after high-risk versus low-risk EGS (307.88 [SD 119.32] vs 345.30 [SD 71.54] days, p<0.001). One-year mortality was higher after high-risk procedures (18.10% vs 5.21%, p<0.001). Fewer HDAH were independently associated with age (Coef. -2.28, 95% CI -2.43 to -2.14), Black race (Coef. -8.30, 95% CI -12.89 to -3.71), dementia (Coef. -49.74, 95% CI -53.97 to -45.50), >=2 comorbidities (Coef. -16.34, 95% CI -20.81 to -11.87), and frailty. Dementia was associated with a greater reduction in HDAH after low-risk versus high-risk procedures. CONCLUSIONS: High-risk EGS was associated with approximately 1 month fewer HDAH in older adults. Dementia and frailty were major predictors of reduced HDAH and should inform patient-centered perioperative counseling.