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The First Clue: Admission Source as a Predictor of Risk in Emergency Surgery Among Older Adults
Ioannis Karikis1, Uriel Rubinovich1, Yasmin Arda1
1Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts.
Introduction:
Admission source may serve as an early indicator of baseline vulnerability in older adults undergoing emergency general surgery (EGS). We aimed to evaluate the association between admission source and postoperative outcomes in this population.
Methods:
In this retrospective cohort study using 2013-2017 American College of Surgeons National Surgical Quality Improvement Program, we identified patients aged ≥ 65 y who underwent EGS. Admission source was categorized as home, nursing facility, or interhospital transfer. The primary outcome was 30-d mortality. Secondary outcomes included in-hospital mortality, composite and infectious complications, and other NSQIP-defined complications. Multivariable logistic regression was used to evaluate associations between admission source and outcomes, adjusting for demographics, American Society of Anesthesiologists, 5-item modified frailty index, comorbidities, laboratory values, and operative factors.
Results:
Among 67,869 patients, 80.4% were admitted from home, 3.9% from nursing facilities, and 15.7% via interhospital transfer. Compared to home admissions, patients from nursing facilities had higher odds of 30-d mortality (adjusted odds ratio [aOR]: 1.28, 95% confidence interval [CI]: 1.12-1.45), composite complications (aOR: 1.15, 95% CI: 1.02-1.28), infectious complications (aOR: 1.25, 95% CI: 1.12-1.39), and prolonged mechanical ventilation (>48 h) (aOR: 1.25, 95% CI: 1.09-1.42). Interhospital transfers also demonstrated increased odds of 30-d mortality (aOR: 1.16, 95% CI: 1.07-1.26), and prolonged ventilation (> 48 h) (aOR: 1.22, 95% CI: 1.12-1.32).
Conclusions:
Admission source is independently associated with adverse postoperative outcomes in older adults undergoing EGS. Risk was greatest among patients admitted from nursing facilities, though interhospital transfers also demonstrated elevated risk. Incorporating this early variable into preoperative risk stratification may improve risk assessment and perioperative care planning for this high-risk population.
