After Inpatient Surgery, Over Half Adults Experience Some Loss of Independence Interview with:

Julia Berian, MD, MS ACS Clinical Research Scholar American College of Surgeons Chicago, IL 60611

Dr. Julia Berian,

Julia Berian, MD, MS
ACS Clinical Research Scholar
American College of Surgeons
Chicago, IL 60611 What is the background for this study? What are the main findings?

Response: The US population is rapidly aging and older adults consume a disproportionate share of operations. Older adults experience a high rate of postoperative complications, which can affect quality of life. In this study, function, mobility and living situation are considered together as independent living. The study examined a large surgical database for the occurrence of loss of independence (defined as a decline in function or mobility, or increased care needs in one’s living situation) and its relationship to traditional outcomes such as readmission and death after the time of discharge. Patients included in the study were age 65 or older and underwent an inpatient surgical operation. Loss of independence was assessed at the time of discharge. Readmission and death-after-discharge were assessed up to 30 days postoperatively. What should readers take away from your report?

Response: After inpatient surgery, over half of older adults in our sample (59.6%) experienced some form of loss of independence – decline in mobility, function or increased care needs in their living situation (such as new skilled care at home or discharge to a facility). Approximately one quarter (26.6%) experienced functional decline, one third (32.0%) experienced mobility decline and 46.0% had increased care needs (18.2% discharged to non-home facility or 27.8% discharged to home with additional care needs such as skilled services). In order to know which patients might experience loss of independence, a multivariable regression with forward selection identified several risk factors. Advanced age (85 or older), having experienced a fall within the year prior to the operation, and increasing lengths of postoperative stay were strongly associated with increased risk for loss of independence.

Though patients may value function, mobility and living situation as outcomes, they are not commonly tracked in traditional quality metrics. This study sought to evaluate the relationship of such “loss of independence” with more traditional outcomes, readmission and death-after-discharge. In multivariable regression models, loss of independence was the second strongest factor associated with readmission (Odds Ratio 1.7, 95% Confidence Interval 1.4-2.2) and the strongest factor associated with death after discharge (Odds Ratio 6.7, 95% CI 2.4-19.3). What recommendations do you have for future research as a result of this study?

Response: As our healthcare system moves toward value, it is extremely important to measure outcomes that matter to patients. Consistently tracking patient-centered outcomes (such as loss of independence) will provide a new target for quality improvement. Postoperative care pathways should focus on maintaining function and mobility during the hospital stay, in order to safely promoting independent living thereafter. Such efforts may ultimately contribute to improving readmission rates, death after discharge and patient experience. Thank you for your contribution to the community.


Julia R. Berian, Sanjay Mohanty, Clifford Y. Ko, Ronnie A. Rosenthal, Thomas N. Robinson. Association of Loss of Independence With Readmission and Death After Discharge in Older Patients After Surgical Procedures. JAMA Surgery, 2016; DOI:10.1001/jamasurg.2016.1689

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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Last Updated on July 15, 2016 by Marie Benz MD FAAD