In older adults, high-risk emergency surgery is associated with fewer healthy days at home (HDAH), according to a study published in the Journal of the American College of Surgeons.
As the U.S. population ages, with Baby Boomers needing more care, clinicians are increasingly recognizing that successful surgical outcomes extend beyond survival to include functional recovery, independence, and the ability to return home. These considerations may be especially important for older Black adults, who experience higher rates of chronic conditions that can complicate both surgery and postoperative recovery.
Manuel Castillo-Angeles, M.D., M.P.H., from Brigham and Women’s Hospital in Boston, and colleagues performed a retrospective cohort study using 2017 100 percent Medicare fee-for-service claims with a 1-year look-back and follow-up period to examine whether HDAH better reflects patient-centered recovery after emergency general surgery (EGS). Community-dwelling adults aged 66 years and older who underwent one of seven EGS procedures within 48 hours of urgent/emergent admission were identified and stratified as low- or high-risk. HDAH was calculated from surgery through 365 days.
Overall, 32.95 percent of the 29,828 older adults underwent a high-risk procedure. The researchers observed a lower mean HDAH after high- versus low-risk EGS (307.88 versus 345.30 days). Higher one-year mortality was seen after high-risk procedures (18.10 versus 5.21 percent). Independent associations were seen for fewer HDAH with age, Black race, dementia, having two or more comorbidities, and frailty. After low- versus high-risk procedures, dementia was associated with a greater reduction in HDAH.
“Healthy days at home captures what patients can do after surgery, not just whether they survive,” Castillo-Angeles said in a statement. “It reflects independence, recovery, and quality of life in ways traditional metrics often miss.”
One author disclosed ties to Pfizer.
Research shows that Black adults face higher rates of chronic conditions — including hypertension, diabetes, chronic kidney disease (CKD), and heart disease — that can increase surgical complexity and prolong recovery. Because of these comorbidities, returning home safely after emergency surgery may require greater multidisciplinary support than simply surviving hospitalization. “Days at home” may be an especially meaningful patient-centered outcome when discussing goals of care with older Black adults and their families.
The study’s findings reinforce that recovery after emergency surgery extends well beyond the operating room.
Rather than just focusing solely on operative mortality, providers should discuss with their patients:
Research has found persistent racial disparities in emergency general surgery. Older Black patients experience higher rates of postoperative complications, such as sepsis, venous thromboembolism, and unplanned intubation, than older white patients, despite complex patterns in mortality outcomes. More recent national research has also shown that Black patients are more likely to undergo emergency rather than elective surgery and are less likely to receive minimally invasive approaches, contributing to longer hospital stays and readmissions.
Here are some approaches clinicians can take to better support older Black patients before and during recovery after emergency surgery:
The latest research highlights an important shift in how providers should evaluate surgical success in older adults. For many patients — and particularly older Black adults who often face a higher burden of chronic disease and barriers to recovery — the goal is not simply surviving surgery but regaining independence and maximizing healthy days at home. Incorporating patient-centered outcomes into perioperative planning may help clinicians deliver more equitable, recovery-focused care.
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