Discharging a patient to a skilled nursing facility or other type of post-acute care facility after surgery can add more than $5,000 to care costs and is associated with worse outcomes for older adult patients. According to a study published in the Journal of the American College of Surgeons (JACS), discharge to a post-acute care setting may be a valuable benchmark to help hospitals evaluate how they are serving older adult surgical patients.
"The research shows that some discharges to a skilled nursing facility or other post-acute care facility postoperatively are preventable," said lead study author Sarah L. Remer, MD, a research fellow with the Division of Research and Optimal Patient Care at the American College of Surgeons (ACS) and a general surgery resident at Loyola University Medical Center in Maywood, Illinois. "By utilizing this benchmark to evaluate performance compared to peers, hospitals can focus on some of the interventions that can prevent discharge to a post-acute care facility."
"Research shows that prehabilitation and similar perioperative mobility programs can prevent discharge to a non-home facility; investing time and effort in these kinds of programs to send patients home after surgery instead of sending them to a non-home facility may be worthwhile," she said.
The study used data from hospitals participating in the ACS National Surgical Quality Improvement Program (NSQIP), a data registry designed to improve hospital-wide quality across all surgical departments. The analysis included 494 hospitals and 277,160 patients aged 65 years or older. The researchers used a model to identify high and low outliers among the studied hospitals based on the odds ratio of discharging patients to post-acute care facilities.
Key Findings
11.2% (30,907) of older adult patients were discharged to a post-acute care facility, most of whom were inpatient cases.
84 hospitals (17%) were low outliers, meaning their rate of discharge to post-acute care facilities was below the norm, 119 (24.1%) were high outliers, and almost 60% of hospitals performed as expected. A clinically significant number of hospitals remained high and low outliers.
When the 25% of patients considered at highest risk for discharge to a post-acute care facility were separated from the rest of the study population, 32.9% were discharged to a post-acute care facility.
The study states that using discharge to an acute-care facility as a benchmark could allow surgeons and hospital administrators to evaluate their institution's performance and identify possible areas for improvement, drawing on previously published evidence suggesting that NSQIP benchmarking, along with rigorous data analysis and quality improvement initiatives, improves patient care.
"Research has demonstrated that there are interventions that can mitigate some unnecessary discharge to post-acute care facilities, such as screening patients at highest risk for poor outcomes, including discharge to post-acute care, and then utilizing those screenings to focus interventions on those high-risk patients, such as prehabilitation or more targeted physical therapy during the perioperative period," Dr. Remer said.
Dr. Remer added that hospitals can also adopt quality improvement initiatives such as the ACS Geriatric Surgery Verification program or similar interventions to decrease the number of patients discharged to post-acute care.
Study co-authors are Lynn Zhou, PhD; Mark E. Cohen, PhD; Marcia M. Russell, MD, FACS; Ronnie Rosenthal, MD, MS, FACS; and Clifford Y. Ko, MD, MS, MSHS, FACS, FASCRS.
This study was presented at the American Geriatrics Society 2025 annual meeting in Chicago, Illinois.
The study is published as an article in press on the JACS website.
Citation: Remer SL, Zhou L, Cohen ME, et al. Discharge to Post-Acute Care as a Benchmarking Metric for Elderly Surgical Patients. Journal of the American College of Surgeons, 2025. DOI: 10.1097/XCS.0000000000001495
