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Over 65s at higher risk of readmission after ambulatory surgery

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Patients aged 65 and older are much more likely to be readmitted within 30 days of ambulatory surgery than younger patients, regardless of their health before the procedure, a study has shown.

The US study found for the first time that age was an independent risk factor for complications resulting from surgery carried out in outpatients settings.

“When patients are sent home on the same day, a lot is required of them to take care of themselves”

Gildasio De Oliveira

Researchers, from Northwestern University in Illinois, suggest the likely cause of the finding is difficulty understanding medication dosing and discharge instructions, as well as cognitive impairment among older patients.

Over a 30-day period, seniors were 54% more likely to be readmitted to hospital compared to patients younger than 65 years, after accounting for differences in other medical problems.

The study, published in the Journal of the American Geriatrics Society, examined data on 53,667 patients who underwent ambulatory surgery in academic medical centres across the US.

Study author Dr Gildasio De Oliveira said: “Age was the biggest factor associated with readmission and complications.

“It’s not because they are sicker, it’s because they are older and have trouble understanding their discharge instructions and medication dosing, which often are not clearly explained,” he added.

To prevent readmissions, seniors need clearer, more understandable discharge instructions and to be evaluated for their ability to care for themselves after surgery, said Dr De Oliveira.

“When patients are sent home on the same day, a lot is required of them to take care of themselves, and it’s beyond the capability of a lot of older individuals,” he said. “They have to administer opioids and monitor themselves for emergency problems such as bleeding or infection.”

“Age was the biggest factor associated with readmission and complications”

Gildasio De Oliveira

He noted that older patients may have difficulty understanding how medicine is prescribed and take too much or too little, potentially leading to cardiovascular problems, poor wound healing and increased pain.

In another study currently underway at Northwestern University, researchers noticed that a patient, who had had a lumpectomy, removed her sterile strips holding the wound together instead of just changing the gauze.

As a result, she had to return to the surgeon. Another patient took four opioid pills an hour instead of four a day and ended up in the emergency room.

Dr De Oliveira suggested the solution was to design discharge instructions tailored to seniors.

It should also be confirmed before undergoing ambulatory surgery that they were able to take care of themselves at home and had support.

“If not, patients should be admitted to the hospital after surgery or have some type of formal support by a nurse to help them at home,” said Dr De Oliveira.

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Readers' comments (2)

  • Of course many over 65 year olds may live alone having lost a partner. So not only are they left to care for themselves they are recovering from procedures which once would have required an in patient stay, and having to redress wounds and manage medication. Is it any wonder that they are at higher risk. If there were enough community nursing staff there would be someone to check up on them, however we all know that care in the community for many is just a myth!

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  • I would flatly refuse day surgery. patients need good post op observation and lots of TLC. Friends who live nowhere near me have had very poor experiences of being sent home too early and with the impression there is no professional help available and the services cannot cope and don't really care - not really what national health care and services should be all about.

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