• Zara Cooper, Elizabeth J Lilley, Evan Bollens-Lund, Susan L Mitchell, Christine S Ritchie, Stuart R Lipstiz, and Amy S Kelley.
• The Center for Surgery and Public Health, Boston, Massachusetts.
• J Am Geriatr Soc. 2018 Nov 1; 66 (11): 2072-2078.

ObjectivesTo quantify preoperative illness burden in older adults undergoing emergency major abdominal surgery (EMAS), to examine the association between illness burden and postoperative outcomes, and to describe end-of-life care in the year after discharge.DesignRetrospective study using data from Health and Retirement Study interviews linked to Medicare claims (2000-2012).SettingNational population-based dataset.ParticipantsMedicare beneficiaries who underwent EMAS.MeasurementsHigh illness burden, defined as ≥2 of the following vulnerabilities: functional dependence, dementia, use of helpers, multimorbidity, poor prognosis, high healthcare utilization. In-hospital outcomes were complications and mortality. Postdischarge outcomes included emergency department (ED) visits, hospitalization, intensive care unit (ICU) stay, and 365-day mortality. For individuals discharged alive who died within 365 days of surgery, outcomes included hospice use, hospitalization, ICU use, and ED use in the last 30 days of life. Multivariable regression was used to determine the association between illness burden and outcomes.ResultsOf 411 participants, 57% had high illness burden. More individuals with high illness burden had complications (45% vs 28% p=0.00) and in-hospital death (20% vs 9%, p=0.00) than those without. After discharge (n=349), individuals with high illness burden experienced more ED visits (57% vs 46%, P=.04) and were more likely to die (35% vs 13%, p=0.00). Of those who died after discharge (n=86), 75% had high illness burden, median survival was 67 days (range 21-141 days), 48% enrolled in hospice, 32% died in the hospital, 23% were in the ICU in the last 30 days of life and 37% had an ED visit in the last 30 days of life.ConclusionMost older adults undergoing EMAS have preexisting high illness burden and experience high mortality and healthcare use in the year after surgery, particularly near the end of life. Concurrent surgical and palliative care may improve quality of life and end-of-life care in these people. J Am Geriatr Soc 66:2072-2078, 2018.© 2018, Copyright the Authors Journal compilation © 2018, The American Geriatrics Society.

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