Postoperative Outcomes and Recovery Trajectory Among Patients with Gastrointestinal Cancer Undergoing Emergency...

Area of Science:

• Geriatric surgery
• Gastrointestinal oncology
• Health services research

Background:

• Perioperative metrics fail to capture long-term recovery for older adults with GI cancer undergoing emergency surgery.
• Prolonged institutional dependence is a significant issue post-discharge.

Purpose of the Study:

• To characterize 12-month recovery trajectories using days elsewhere than home (DEH).
• To identify factors associated with protracted recovery (PR) and sustained high DEH (SH-DEH).

Main Methods:

• Retrospective cohort study of SEER-Medicare data (2005-2019) for patients aged ≥66 years.
• Group-based trajectory modeling analyzed monthly DEH over 12 months.
• Modified Poisson regression identified predictors of PR and SH-DEH.

Main Results:

• Four distinct DEH trajectories were identified: routine recovery (42.5%), chronically dependent (37.1%), PR (7.2%), and SH-DEH (13.2%).
• SH-DEH was linked to stage IV disease, frailty, high comorbidity index, and intrahepatic cholangiocarcinoma.
• PR was associated with stage IV disease, high comorbidity index, frailty risk, and pancreatic cancer. Postoperative complications, prolonged length of stay, and ICU admission increased PR and SH-DEH likelihood.

Conclusions:

• Older adults with GI cancer exhibit varied DEH recovery patterns after emergency surgery.
• Frailty, advanced disease stage, comorbidities, and postoperative complications are key predictors of prolonged recovery and institutional dependence.