A condition known as post- hospital syndrome (PHS) is a significant risk factor for patients who undergo elective outpatient surgery, according to a study from Loyola in Maywood, IL.
PHS is defined as having been hospitalized during the previous 90 days. The first-of-its-kind study found that among patients with PHS, 7.6% had to be readmitted to the hospital within 30 days of undergoing elective outpatient hernia surgery. By comparison, only 1.6% of non-PHS patients had to be readmitted following hernia surgery.
Also, 8.3% of PHS patients were admitted to the emergency department within 30 days of hernia surgery, compared with 4.3% of non-PHS hernia surgery patients.
“Surgeons must consider all recent inpatient admissions when risk-stratifying patients for ambulatory, elective surgery,” the researchers concluded.
PHS was first identified in an article in The New England Journal of Medicine by Harlan Krumholz, MD, of Yale University School of Medicine. He is the Harold H. Hines, Jr. professor of medicine (cardiology) and professor of investigative medicine and of public health (health policy) in the Institute for Social and Policy Studies. Krumholz defined PHS as “an acquired condition of vulnerability.”
During hospitalization, patients often are sleep-deprived and in pain or discomfort. They receive medications that can alter their mental and physical abilities. They become deconditioned, with loss of muscle mass, reduced cardiac output, etc. Also, patients might not obtain sufficient nutrition if, for example, they are on a ventilator or have to fast before surgery or tests. These problems can impair their recovery and make them more prone to disease and mental errors, Krumholz wrote.
The Loyola researchers analyzed records of 57,988 California patients who underwent hernia repair in 2011, including 1,332 patients who had PHS. Data sets came from the Agency for Healthcare Research and Quality.
Among the PHS patients, the most common reason for their previous hospitalization was gastrointestinal problems (25.1%), followed by cardiovascular problems (12.3%), hip fractures and other injuries (8.2%), and pregnancy-related complications (7.1%). The average length of time between their previous hospitalization and their elective hernia surgery was 48.7 days.
Loyola researchers are doing a follow-up study to determine what measures healthcare providers could take to reduce the negative impact of PHS.
