{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T02:17:01Z","timestamp":1791339421652,"version":"4.3.1"},"reference-count":42,"publisher":"American Medical Association (AMA)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Surg"],"published-print":{"date-parts":[[2025,1,1]]},"abstract":"Importance<\/jats:title>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.<\/jats:p><\/jats:sec>Objective<\/jats:title>To characterize long-term postoperative recovery trajectories.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>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.<\/jats:p><\/jats:sec>Exposure<\/jats:title>Surgical care in VA hospitals.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>Days elsewhere than home (DEH) were counted in 30-day periods for 275 days presurgery and 365 days postsurgery.<\/jats:p><\/jats:sec>Results<\/jats:title>A 5-trajectory solution was optimal and visually similar for both age groups (cases: 179\u202f879 younger [mean age (SD) 51.2 (10.8) years; most were male [154\u202f542 (83.0%)] and 198\u202f803 older [mean (SD) age, 72.2 (6.0) years; 187\u202f996 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%).<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>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.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamasurg.2024.4691","type":"journal-article","created":{"date-parts":[[2024,10,23]],"date-time":"2024-10-23T15:31:49Z","timestamp":1729697509000},"page":"56","source":"Crossref","is-referenced-by-count":16,"title":["Long-Term Trajectories of Postoperative Recovery in Younger and Older Veterans"],"prefix":"10.1001","volume":"160","author":[{"given":"Michael A.","family":"Jacobs","sequence":"first","affiliation":[{"name":"Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carly A.","family":"Jacobs","sequence":"additional","affiliation":[{"name":"Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Orna","family":"Intrator","sequence":"additional","affiliation":[{"name":"Geriatrics and Extended Care Data and Analysis Center, Canandaigua VA Medical Center, Canandaigua, New York"},{"name":"Department of Public Health Sciences, University of Rochester, Rochester, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rajesh","family":"Makineni","sequence":"additional","affiliation":[{"name":"Geriatrics and Extended Care Data and Analysis Center, Canandaigua VA Medical Center, Canandaigua, New York"},{"name":"Department of Public Health Sciences, University of Rochester, Rochester, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ada","family":"Youk","sequence":"additional","affiliation":[{"name":"Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania"},{"name":"Department of Biostatistics, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monique Y.","family":"Boudreaux-Kelly","sequence":"additional","affiliation":[{"name":"Office of Research and Development StatCore, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer L.","family":"McCoy","sequence":"additional","affiliation":[{"name":"Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania"},{"name":"Office of Research and Development StatCore, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruce","family":"Kinosian","sequence":"additional","affiliation":[{"name":"Geriatrics and Extended Care Data Analysis, Cpl. Michael J Crescenz VA Medical Center, Philadelphia, Pennsylvania"},{"name":"Center for Health Equity Research and Promotion, Cpl. Michael J Crescenz VA Medical Center, Philadelphia, Pennsylvania"},{"name":"Department of Medicine, University of Pennsylvania, Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paula K.","family":"Shireman","sequence":"additional","affiliation":[{"name":"Departments of Medical Physiology and Primary Care & Rural Medicine, College of Medicine, Texas A&M University, Bryan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel E.","family":"Hall","sequence":"additional","affiliation":[{"name":"Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania"},{"name":"Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania"},{"name":"Geriatric Research Education and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania"},{"name":"Wolff Center at University of Pittsburgh Medical Center, Pittsburgh, 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