Hospitals can curb costly post-acute discharges with targeted periop programs, study finds

Editor's Note

One in 10 older adults and one-third of the highest risk patients are discharged to post-acute care facilities after major surgery, driving up costs and worsening outcomes. According to the American College of Surgeons (ACS) in an August 25 release on a Journal of the American College of Surgeons study, discharge to such facilities could serve as a new benchmark for hospital performance, helping identify where interventions might reduce reliance on non-home care.

Per the release, discharges to skilled nursing or other post-acute care facilities can add more than $5,000 per patient while correlating with poorer recovery. The study’s lead author, Sarah L. Remer, MD, emphasized that some of these discharges are preventable and that hospitals can use benchmarking to compare themselves against peers and refine their perioperative care strategies.

The analysis drew on ACS National Surgical Quality Improvement Program data from 494 hospitals and 277,160 patients aged 65 and older. Results showed 11.2% of patients were discharged to a post-acute facility, mostly after inpatient procedures. Nearly one-quarter of hospitals were high outliers, meaning their rates exceeded the norm, while 17% were low outliers, performing better than expected. Among the 25% of patients at highest risk, nearly one in three went to a post-acute setting.

Prehabilitation, mobility programs, and targeted physical therapy offer proven ways to keep patients at home after surgery. Screening patients at highest risk for poor outcomes can help direct these interventions more effectively. Dr Remer also highlighted established programs such as the ACS Geriatric Surgery Verification initiative as potential models for hospitals aiming to improve.

The outlet reports using discharge destination as a benchmark builds on evidence that rigorous data analysis and quality improvement initiatives enhance patient outcomes. By adopting this metric, hospitals may better track performance and reduce unnecessary transfers, aligning surgical care with both cost efficiency and patient-centered recovery.