Long-Term Trajectories of Postoperative Recovery in Younger and Older Veterans.

IF 15.7 1区 医学 Q1 SURGERY
Michael A Jacobs,Carly A Jacobs,Orna Intrator,Rajesh Makineni,Ada Youk,Monique Y Boudreaux-Kelly,Jennifer L McCoy,Bruce Kinosian,Paula K Shireman,Daniel E Hall
{"title":"Long-Term Trajectories of Postoperative Recovery in Younger and Older Veterans.","authors":"Michael A Jacobs,Carly A Jacobs,Orna Intrator,Rajesh Makineni,Ada Youk,Monique Y Boudreaux-Kelly,Jennifer L McCoy,Bruce Kinosian,Paula K Shireman,Daniel E Hall","doi":"10.1001/jamasurg.2024.4691","DOIUrl":null,"url":null,"abstract":"Importance\r\nMajor surgery sometimes involves long recovery or even permanent institutionalization. Little is known about long-term trajectories of postoperative recovery, as surgical registries are limited to 30-day outcomes and care can occur across various institutions.\r\n\r\nObjective\r\nTo characterize long-term postoperative recovery trajectories.\r\n\r\nDesign, Setting, and Participants\r\nThis retrospective cohort study used Veterans Affairs (VA) Surgical Quality Improvement Program data (2016 through 2019) linked to the Residential History File, combining data from the VA, Medicare/Medicaid, and other sources to capture most health care utilization by days. Patients were divided into younger (younger than 65 years) or older (65 years or older) subgroups, as Medicare eligibility is age dependent. Latent-class, group-based trajectory models were developed for each group. These data were analyzed from February 2023 through August 2024.\r\n\r\nExposure\r\nSurgical care in VA hospitals.\r\n\r\nMain Outcomes and Measures\r\nDays elsewhere than home (DEH) were counted in 30-day periods for 275 days presurgery and 365 days postsurgery.\r\n\r\nResults\r\nA 5-trajectory solution was optimal and visually similar for both age groups (cases: 179 879 younger [mean age (SD) 51.2 (10.8) years; most were male [154 542 (83.0%)] and 198 803 older [mean (SD) age, 72.2 (6.0) years; 187 996 were male (97.6%)]). Most cases were in trajectories 1 and 2 (T1 and T2). T1 cases returned home within 30 days (younger, 74.0%; older, 54.2%), while T2 described delayed recovery within 30 to 60 days (younger, 21.6%; older, 35.5%). Trajectory 3 (T3) and trajectory 4 (T4) were similar for the first 30 days postsurgery, but subsequently separated with T3 representing protracted recovery of 6 months or longer (younger, 2.7%; older, 3.8%) and T4 indicating long-term loss of independence (younger, 1.3%; older, 5.2%). Few (trajectory 5) were chronically dependent, with 20 to 30 DEH per month before and after surgery (younger, 0.4%; older, 1.3%).\r\n\r\nConclusions and Relevance\r\nIn this study, trajectory models demonstrated clinically meaningful differences in postoperative recovery that should inform surgical decision-making. Registries should include longer-term outcomes to enable future research to distinguish patients prone to long-term loss of independence vs protracted, but meaningful recovery.","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":null,"pages":null},"PeriodicalIF":15.7000,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"JAMA surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1001/jamasurg.2024.4691","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"SURGERY","Score":null,"Total":0}
引用次数: 0

Abstract

Importance Major surgery sometimes involves long recovery or even permanent institutionalization. Little is known about long-term trajectories of postoperative recovery, as surgical registries are limited to 30-day outcomes and care can occur across various institutions. Objective To characterize long-term postoperative recovery trajectories. Design, Setting, and Participants This retrospective cohort study used Veterans Affairs (VA) Surgical Quality Improvement Program data (2016 through 2019) linked to the Residential History File, combining data from the VA, Medicare/Medicaid, and other sources to capture most health care utilization by days. Patients were divided into younger (younger than 65 years) or older (65 years or older) subgroups, as Medicare eligibility is age dependent. Latent-class, group-based trajectory models were developed for each group. These data were analyzed from February 2023 through August 2024. Exposure Surgical care in VA hospitals. Main Outcomes and Measures Days elsewhere than home (DEH) were counted in 30-day periods for 275 days presurgery and 365 days postsurgery. Results A 5-trajectory solution was optimal and visually similar for both age groups (cases: 179 879 younger [mean age (SD) 51.2 (10.8) years; most were male [154 542 (83.0%)] and 198 803 older [mean (SD) age, 72.2 (6.0) years; 187 996 were male (97.6%)]). Most cases were in trajectories 1 and 2 (T1 and T2). T1 cases returned home within 30 days (younger, 74.0%; older, 54.2%), while T2 described delayed recovery within 30 to 60 days (younger, 21.6%; older, 35.5%). Trajectory 3 (T3) and trajectory 4 (T4) were similar for the first 30 days postsurgery, but subsequently separated with T3 representing protracted recovery of 6 months or longer (younger, 2.7%; older, 3.8%) and T4 indicating long-term loss of independence (younger, 1.3%; older, 5.2%). Few (trajectory 5) were chronically dependent, with 20 to 30 DEH per month before and after surgery (younger, 0.4%; older, 1.3%). Conclusions and Relevance In this study, trajectory models demonstrated clinically meaningful differences in postoperative recovery that should inform surgical decision-making. Registries should include longer-term outcomes to enable future research to distinguish patients prone to long-term loss of independence vs protracted, but meaningful recovery.
年轻退伍军人和老年退伍军人术后恢复的长期轨迹。
重要性大手术有时需要长期恢复,甚至需要长期住院。这项回顾性队列研究使用了退伍军人事务局(VA)的手术质量改进计划数据(2016 年至 2019 年),这些数据与居住历史档案相连接,结合了退伍军人事务局、医疗保险/医疗补助计划和其他来源的数据,按天数记录了大部分医疗服务的使用情况。由于医疗保险资格取决于年龄,因此患者被分为年轻(65 岁以下)或年长(65 岁或以上)亚组。为每个组别开发了基于组别的潜类轨迹模型。这些数据的分析时间为 2023 年 2 月至 2024 年 8 月。主要结果和衡量标准在手术前 275 天和手术后 365 天的 30 天内,对在家以外的时间(DEH)进行统计:179 879 个年轻病例[平均年龄(标清)51.2(10.8)岁;大多数为男性[154 542(83.0%)]和 198 803 个年长病例[平均年龄(标清)72.2(6.0)岁;187 996 个为男性(97.6%)]]。大多数病例属于轨迹 1 和 2(T1 和 T2)。T1 病例在 30 天内返回家中(年轻人,74.0%;老年人,54.2%),而 T2 病例在 30 至 60 天内延迟康复(年轻人,21.6%;老年人,35.5%)。轨迹 3(T3)和轨迹 4(T4)在术后头 30 天内的情况相似,但随后就分开了,T3 代表 6 个月或更长时间的长期恢复(年轻人,2.7%;老年人,3.8%),而 T4 则表示长期丧失独立性(年轻人,1.3%;老年人,5.2%)。极少数人(轨迹 5)长期依赖他人,术前和术后每月有 20 到 30 次 DEH(年轻人,0.4%;老年人,1.3%)。结论和相关性在这项研究中,轨迹模型显示了术后恢复中具有临床意义的差异,应为手术决策提供参考。注册登记应包括更长期的结果,以便未来的研究能够区分容易长期丧失独立性的患者和恢复期较长但有意义的患者。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
JAMA surgery
JAMA surgery SURGERY-
CiteScore
20.80
自引率
3.60%
发文量
400
期刊介绍: JAMA Surgery, an international peer-reviewed journal established in 1920, is the official publication of the Association of VA Surgeons, the Pacific Coast Surgical Association, and the Surgical Outcomes Club.It is a proud member of the JAMA Network, a consortium of peer-reviewed general medical and specialty publications.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信