{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,3]],"date-time":"2026-05-03T04:31:06Z","timestamp":1777782666600,"version":"3.51.4"},"reference-count":35,"publisher":"SAGE Publications","issue":"8","license":[{"start":{"date-parts":[[2020,8,1]],"date-time":"2020-08-01T00:00:00Z","timestamp":1596240000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Appl Gerontol"],"published-print":{"date-parts":[[2021,8]]},"abstract":"<jats:p>To identify patient risk factors for nonhome discharge (NHD) for home-dwelling older patients undergoing surgery, we performed a retrospective cohort study of patients aged \u226565 years undergoing elective surgery between 2014 and 2016 using the geriatric research file from the National Surgical Quality Improvement Program (NSQIP). Multivariable logistic regression examined the association between preoperative demographics, comorbidities, and functional status and NHD to determine which factors are most strongly predictive of NHD. Risk of NHD was higher among those of age &gt;85 years, age 75 to 85 years, Black race, with body mass index (BMI) &gt;30, dyspnea with exertion or at rest, partially or totally dependent in activities of daily living (ADLs), preoperative steroid use, preoperative wound infection, use of a mobility aid, fall within 3 months, or living alone at home without support. NHDs were statistically more likely among orthopedic, neurosurgery, or cardiac surgery interventions. Understanding individual patient\u2019s risks and setting expectations for likely postoperative course is integral to appropriate preoperative counseling and preoperative optimization.<\/jats:p>","DOI":"10.1177\/0733464820944699","type":"journal-article","created":{"date-parts":[[2020,8,1]],"date-time":"2020-08-01T08:45:48Z","timestamp":1596271548000},"page":"856-864","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":12,"title":["Preoperative Risk Factors for Nonhome Discharge of Home-Dwelling Geriatric Patients Following Elective Surgery"],"prefix":"10.1177","volume":"40","author":[{"given":"John C.","family":"Warwick","sequence":"first","affiliation":[{"name":"Brigham and Women\u2019s Hospital and Harvard Medical School, Boston, MA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ethan Y.","family":"Brovman","sequence":"additional","affiliation":[{"name":"Tufts Medical Center and University School of Medicine, Boston, MA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sascha S.","family":"Beutler","sequence":"additional","affiliation":[{"name":"Brigham and Women\u2019s Hospital and Harvard Medical School, Boston, MA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0516-5977","authenticated-orcid":false,"given":"Richard D.","family":"Urman","sequence":"additional","affiliation":[{"name":"Brigham and Women\u2019s Hospital and Harvard Medical School, Boston, MA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2020,8,1]]},"reference":[{"key":"bibr1-0733464820944699","doi-asserted-by":"crossref","unstructured":"Alvarez-Nebreda M. L., Bentov N., Urman R. D., Setia S., Huang J. C., Pfeifer K. Javedan H. (2018). Recommendations for preoperative management of frailty from the Society for Perioperative Assessment and Quality Improvement (SPAQI). Journal of Clinical Anesthesia, 47, 33\u201342. https:\/\/doi.org\/10.1016\/j.jclinane.2018.02.011","DOI":"10.1016\/j.jclinane.2018.02.011"},{"key":"bibr2-0733464820944699","unstructured":"American College of Surgeons. (2018). NSQIP participant use data file (PUF). https:\/\/www.facs.org\/-\/media\/files\/quality-programs\/nsqip\/nsqip_puf_userguide_2018.ashx"},{"key":"bibr3-0733464820944699","unstructured":"American College of Surgeons. (2019). American College of Surgeons geriatric surgery verification program standards. https:\/\/www.facs.org\/quality-programs\/geriatric-surgery\/standards"},{"key":"bibr4-0733464820944699","doi-asserted-by":"crossref","unstructured":"Arias F., Wiggins M., Urman R. D., Armstrong R., Pfeifer K., Bader A. M., Libon D. J., Chopra A., Price C. C. (2020). Rapid in-person cognitive screening in the preoperative setting: Test considerations and recommendations from the Society for Perioperative Assessment and Quality Improvement (SPAQI). Journal of Clinical Anesthesia, 62, 109724. https:\/\/doi.org\/10.1016\/j.jclinane.2020.109724","DOI":"10.1016\/j.jclinane.2020.109724"},{"key":"bibr5-0733464820944699","doi-asserted-by":"crossref","unstructured":"Arya S., Long C. A., Brahmbhatt R., Shafii S., Brewster L. P., Veeraswamy R. Johanning J. M. (2016). Preoperative frailty increases risk of nonhome discharge after elective vascular surgery in home-dwelling patients. Annals of Vascular Surgery, 35, 19\u201329. https:\/\/doi.org\/10.1016\/j.avsg.2016.01.052","DOI":"10.1016\/j.avsg.2016.01.052"},{"key":"bibr6-0733464820944699","doi-asserted-by":"crossref","unstructured":"Bekelis K., Rahmani R., Kim-Hyung J., Calnan D., MacKenzie T. A. (2017). Association of prior falls with adverse outcomes after neurosurgical operations in the elderly. World Neurosurgery, 99, 320\u2013325. https:\/\/doi.org\/10.1016\/j.wneu.2016.12.023","DOI":"10.1016\/j.wneu.2016.12.023"},{"key":"bibr7-0733464820944699","doi-asserted-by":"crossref","unstructured":"Boitano L. T., Iannuzzi J. C., Tanious A., Mohebali J., Schwartz S. I., Clouse W. D., Conrad M. F. (2019). Predicting postoperative destination through preoperative evaluation in elective open aortic aneurysm repair. Journal of Surgical Research, 235, 543\u2013550. https:\/\/doi.org\/10.1016\/j.jss.2018.10.039","DOI":"10.1016\/j.jss.2018.10.039"},{"key":"bibr8-0733464820944699","doi-asserted-by":"crossref","unstructured":"Brovman E. Y., Wallace F. C., Weaver M. J., Beutler S. S., Urman R. D. (2019). Anesthesia type is not associated with postoperative complications in the care of patients with lower extremity traumatic fractures. Anesthesia & Analgesia, 129, 1034\u20131042. https:\/\/doi.org\/10.1213\/ANE.0000000000004270","DOI":"10.1213\/ANE.0000000000004270"},{"key":"bibr9-0733464820944699","doi-asserted-by":"crossref","unstructured":"Brovman E. Y., Walsh E. C., Burton B. N., Kuo C. E., Lindvall C., Gabriel R. A., Urman R. D. (2018). Postoperative outcomes in patients with a do-not-resuscitate (DNR) order undergoing elective procedures. Journal of Clinical Anesthesia, 48, 81\u201388. https:\/\/doi.org\/10.1016\/j.jclinane.2018.05.007","DOI":"10.1016\/j.jclinane.2018.05.007"},{"key":"bibr10-0733464820944699","doi-asserted-by":"crossref","unstructured":"Burguete D., Mokdad A. A., Augustine M. M., Minter R., Mansour J. C., Choti M. A., Polanco P. M. (2019). Non-home discharge and prolonged length of stay after cytoreductive surgery and HIPEC. Journal of Surgical Research, 233, 360\u2013367. https:\/\/doi.org\/10.1016\/j.jss.2018.08.018","DOI":"10.1016\/j.jss.2018.08.018"},{"key":"bibr11-0733464820944699","doi-asserted-by":"crossref","unstructured":"Caldararo M. D., Stein D. E., Poggio J. L. (2016). Nursing home status is an independent risk factor for adverse 30-day postoperative outcomes after common, nonemergent inpatient procedures. The American Journal of Surgery, 212, 202\u2013208. https:\/\/doi.org\/10.1016\/j.amjsurg.2016.02.020","DOI":"10.1016\/j.amjsurg.2016.02.020"},{"key":"bibr12-0733464820944699","doi-asserted-by":"crossref","unstructured":"Cooper L., Abbett S. K., Feng A., Bernacki R. E, Cooper Z., Urman R. D., Frain L. N., Edwards A. F., Blitz J. D., Javedan H., Bader A. M. (2020). Launching a Geriatric Surgery Center: Recommendations from the Society for Perioperative Assessment and Quality Improvement. Journal of The American Geriatrics Society. Online ahead of print (PMID: 32662064). https:\/\/doi.org\/10.1111\/jgs.16681","DOI":"10.1111\/jgs.16681"},{"key":"bibr13-0733464820944699","doi-asserted-by":"crossref","unstructured":"Di Capua J., Somani S., Kim J. S., Lee N. J., Kothari P., Phan K. Cho S. K. (2017). Predictors for patient discharge destination after elective anterior cervical discectomy and fusion. Spine, 42, 1538\u20131544. https:\/\/doi.org\/10.1097\/BRS.0000000000002140","DOI":"10.1097\/BRS.0000000000002140"},{"key":"bibr14-0733464820944699","doi-asserted-by":"crossref","unstructured":"Flanagan P., Kelly R. (2019). Discharge home from hospital: How DIRE can it be? Journal of Applied Gerontology, 38, 530\u2013552. https:\/\/doi.org\/10.1177\/0733464817723089","DOI":"10.1177\/0733464817723089"},{"key":"bibr15-0733464820944699","doi-asserted-by":"crossref","unstructured":"Hall B. L., Hamilton B. H., Richards K., Bilimoria K. Y., Cohen M. E., Ko C. Y. (2009). Does surgical quality improve in the American College of Surgeons National Surgical Quality Improvement Program: An evaluation of all participating hospitals. Annals of Surgery, 250, 363\u2013376. https:\/\/doi.org\/10.1097\/SLA.0b013e3181b4148f","DOI":"10.1097\/SLA.0b013e3181b4148f"},{"key":"bibr16-0733464820944699","doi-asserted-by":"crossref","unstructured":"Harris M. J., Brovman E. Y., Urman R. D. (2019). Clinical predictors of postoperative delirium, functional status, and mortality in geriatric patients undergoing non-elective surgery for hip fracture. Journal of Clinical Anesthesia, 58, 61\u201371. https:\/\/doi.org\/10.1016\/j.jclinane.2019.05.010","DOI":"10.1016\/j.jclinane.2019.05.010"},{"key":"bibr17-0733464820944699","doi-asserted-by":"crossref","unstructured":"Jablonski S. G., Urman R. D. (2019). The growing challenge of the older surgical population. Anesthesiology Clinics, 37, 401\u2013409. https:\/\/doi.org\/10.1016\/j.anclin.2019.04.001","DOI":"10.1016\/j.anclin.2019.04.001"},{"key":"bibr18-0733464820944699","doi-asserted-by":"crossref","unstructured":"Keswani A., Tasi M. C., Fields A., Lovy A. J., Moucha C. S., Bozic K. J. (2016). Discharge destination after total joint arthroplasty: An analysis of postdischarge outcomes, placement risk factors, and recent trends. The Journal of Arthroplasty, 31, 1155\u20131162. https:\/\/doi.org\/10.1016\/j.arth.2015.11.044","DOI":"10.1016\/j.arth.2015.11.044"},{"key":"bibr19-0733464820944699","doi-asserted-by":"crossref","unstructured":"Kripalani S., Theobald C. N., Anctil B., Vasilevskis E. E. (2014). Reducing hospital readmission rates: Current strategies and future directions. Annual Review of Medicine, 65, 471\u2013485. https:\/\/doi.org\/10.1146\/annurev-med-022613-090415","DOI":"10.1146\/annurev-med-022613-090415"},{"key":"bibr20-0733464820944699","doi-asserted-by":"crossref","unstructured":"Marwell J. G., Heflin M. T., McDonald S. R. (2018). Preoperative screening. Clinics in Geriatric Medicine, 34, 95\u2013105. https:\/\/doi.org\/10.1016\/j.cger.2017.08.004","DOI":"10.1016\/j.cger.2017.08.004"},{"key":"bibr21-0733464820944699","doi-asserted-by":"crossref","unstructured":"Murphy M. E., Maloney P. R., McCutcheon B. A., Rinaldo L., Shepherd D., Kerezoudis P. Bydon M. (2017). Predictors of discharge to a nonhome facility in patients undergoing lumbar decompression without fusion for degenerative spine disease. Neurosurgery, 81, 638\u2013649. https:\/\/doi.org\/10.1093\/neuros\/nyx057","DOI":"10.1093\/neuros\/nyx057"},{"key":"bibr22-0733464820944699","doi-asserted-by":"crossref","unstructured":"Newcomer R., Harrington C., Hulett D., Kang T., Ko M., Bindman A. (2018). Health care use before and after entering long-term services and supports. Journal of Applied Gerontology, 37, 26\u201340. https:\/\/doi.org\/10.1177\/0733464816641393","DOI":"10.1177\/0733464816641393"},{"key":"bibr23-0733464820944699","doi-asserted-by":"crossref","unstructured":"Ogink P. T., Karhade A. V., Thio Q., Gormley W. B., Oner F. C., Verlaan J. J., Schwab J. H. (2019). Predicting discharge placement after elective surgery for lumbar spinal stenosis using machine learning methods. European Spine Journal, 28, 1433\u20131440. https:\/\/doi.org\/10.1007\/s00586-019-05928-z","DOI":"10.1007\/s00586-019-05928-z"},{"key":"bibr24-0733464820944699","doi-asserted-by":"crossref","unstructured":"Pattakos G., Johnston D. R., Houghtaling P. L., Nowicki E. R., Blackstone E. H. (2012). Preoperative prediction of non-home discharge: A strategy to reduce resource use after cardiac surgery. Journal of the American College of Surgeons, 214, 140\u2013147. https:\/\/doi.org\/10.1016\/j.jamcollsurg.2011.11.003","DOI":"10.1016\/j.jamcollsurg.2011.11.003"},{"key":"bibr25-0733464820944699","doi-asserted-by":"crossref","unstructured":"Pitter F. T., Jorgensen C. C., Lindberg-Larsen M., Kehlet H. Lundbeck Foundation Center for Fast-track, H. & Knee Replacement Collaborative, G. (2016). Postoperative morbidity and discharge destinations after fast-track hip and knee arthroplasty in patients older than 85 years. Anesthesia & Analgesia, 122, 1807\u20131815. https:\/\/doi.org\/10.1213\/ANE.0000000000001190","DOI":"10.1213\/ANE.0000000000001190"},{"key":"bibr26-0733464820944699","doi-asserted-by":"crossref","unstructured":"Quinn T. D., Brovman E. Y., Aglio L. S., Urman R. D. (2017). Factors associated with an increased risk of perioperative cardiac arrest in emergent and elective craniotomy and spine surgery. Clinical Neurology and Neurosurgery, 161, 6\u201313. https:\/\/doi.org\/10.1016\/j.clineuro.2017.07.014","DOI":"10.1016\/j.clineuro.2017.07.014"},{"key":"bibr27-0733464820944699","doi-asserted-by":"crossref","unstructured":"Quinn T. D., Wolczynski P., Sroka R., Urman R. D. (2018). Creating a pathway for multidisciplinary shared decision-making to improve communication during preoperative assessment. Anesthesiology Clinics, 36, 653\u2013662. https:\/\/doi.org\/10.1016\/j.anclin.2018.07.011","DOI":"10.1016\/j.anclin.2018.07.011"},{"key":"bibr28-0733464820944699","doi-asserted-by":"crossref","unstructured":"Revenig L. M., Canter D. J., Taylor M. D., Tai C., Sweeney J. F., Sarmiento J. M. Ogan K. (2013). Too frail for surgery? Initial results of a large multidisciplinary prospective study examining preoperative variables predictive of poor surgical outcomes. Journal of the American College of Surgeons, 217, 665.e\u2013670.e1. https:\/\/doi.org\/10.1016\/j.jamcollsurg.2013.06.012","DOI":"10.1016\/j.jamcollsurg.2013.06.012"},{"key":"bibr29-0733464820944699","doi-asserted-by":"crossref","unstructured":"Sacks G. D., Lawson E. H., Dawes A. J., Gibbons M. M., Zingmond D. S., Ko C. Y. (2015). Which patients require more care after hospital discharge? An analysis of post-acute care use among elderly patients undergoing elective surgery. Journal of the American College of Surgeons, 220, 1113.e\u20131121.e1. https:\/\/doi.org\/10.1016\/j.jamcollsurg.2015.02.029","DOI":"10.1016\/j.jamcollsurg.2015.02.029"},{"key":"bibr30-0733464820944699","doi-asserted-by":"crossref","unstructured":"Saleh A., Thirukumaran C., Mesfin A., Molinari R. W. (2017). Complications and readmission after lumbar spine surgery in elderly patients: an analysis of 2,320 patients. Spine Journal, 17, 1106\u20131112. https:\/\/doi.org\/10.1016\/j.spinee.2017.03.019","DOI":"10.1016\/j.spinee.2017.03.019"},{"key":"bibr31-0733464820944699","doi-asserted-by":"crossref","unstructured":"Scarborough J. E., Bennett K. M., Englum B. R., Pappas T. N., Lagoo-Deenadayalan S. A. (2015). The impact of functional dependency on outcomes after complex general and vascular surgery. Annals of Surgery, 261, 432\u2013437. https:\/\/doi.org\/10.1097\/SLA.0000000000000767","DOI":"10.1097\/SLA.0000000000000767"},{"key":"bibr32-0733464820944699","doi-asserted-by":"crossref","unstructured":"Stopa B. M., Robertson F. C., Karhade A. V., Chua M., Broekman M. L. D., Schwab J. H. Gormley W. B. (2019). Predicting nonroutine discharge after elective spine surgery: External validation of machine learning algorithms. Journal of Neurosurgery, 31, 619\u2013773. https:\/\/doi.org\/10.3171\/2019.5.SPINE1987","DOI":"10.3171\/2019.5.SPINE1987"},{"key":"bibr33-0733464820944699","doi-asserted-by":"crossref","unstructured":"Xue Q. L. (2011). The frailty syndrome: Definition and natural history. Clinics in Geriatric Medicine, 27, 1\u201315. https:\/\/doi.org\/10.1016\/j.cger.2010.08.009","DOI":"10.1016\/j.cger.2010.08.009"},{"key":"bibr34-0733464820944699","doi-asserted-by":"crossref","unstructured":"Yang R., Wolfson M., Lewis M. C. (2011). Unique aspects of the elderly surgical population: An anesthesiologist\u2019s perspective. Geriatric Orthopaedic Surgery & Rehabilitation, 2, 56\u201364. https:\/\/doi.org\/10.1177\/2151458510394606","DOI":"10.1177\/2151458510394606"},{"key":"bibr35-0733464820944699","doi-asserted-by":"crossref","unstructured":"Ye I., Phan K., Cheung Z. B., White S. J. W., Nguyen J., Cho B. Cho S. K. (2018). Predictive risk factors of nonhome discharge following elective posterior cervical fusion. World Neurosurgery, 119, e574\u2013e579. https:\/\/doi.org\/10.1016\/j.wneu.2018.07.213","DOI":"10.1016\/j.wneu.2018.07.213"}],"container-title":["Journal of Applied Gerontology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/0733464820944699","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/0733464820944699","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/0733464820944699","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T19:34:49Z","timestamp":1777491289000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/0733464820944699"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,8,1]]},"references-count":35,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2021,8]]}},"alternative-id":["10.1177\/0733464820944699"],"URL":"https:\/\/doi.org\/10.1177\/0733464820944699","relation":{},"ISSN":["0733-4648","1552-4523"],"issn-type":[{"value":"0733-4648","type":"print"},{"value":"1552-4523","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,8,1]]}}}