Home care after elective vascular surgery: still more questions than answers

Home care services support the goal of many patients and caregivers to live independently at home and to ‘age in place’. Home care referrals in the USA have increased nearly 60% from 2002 to 2016 resulting in an over 88% increase in spending to over US$18 billion for Medicare beneficiaries.1 In a recent 2015–2016 survey in Canada, an estimated 881 800 households, or just over 6% of all households, used home care services including nursing and personal/home support services.2 Despite the widespread use of home care services in many countries, relatively little is known about how to optimise patient outcomes in home care. Many questions remain about which patients are most likely to benefit, which services (eg, nursing, therapies, personal care) are most beneficial for which patients and what intensity and duration of services are ideal for different patient populations. Recently, de Mestral and colleagues identified that home care nursing was associated with lower odds of emergency department (ED)visits and rehospitalisations for patients discharged after elective vascular surgeries (ie, carotid endarterectomy, endovascular aortic aneurysm repair and bypass for lower extremity peripheral arterial disease) in Canada.3 This study is important because it adds to the evidence by examining home care in a population very different from the majority of studies focused on the effect of home care on patient outcomes. Most studies focus on patients with heart failure (HF) and the results have been mixed. One major difference to highlight is that the risk for ED visits and rehospitalisations in patients following an elective vascular surgery procedure is lower compared with patients who have an unplanned HF hospitalisation. The former population would have a lower risk of 30-day readmissions (~6%–19% readmission rate) compared with patients with HF who are readmitted more …