CHICAGO — Older adults who undergo high-risk emergency general surgery spend significantly fewer days living independently at home after surgery than those undergoing lower-risk procedures, according to a study published in the Journal of the American College of Surgeons (JACS).
Researchers analyzed outcomes for nearly 30,000 individuals aged 66 and older on Medicare using “healthy days at home,” a patient-centered measure that reflects the number of days patients live independently at home after surgery, excluding time spent in hospitals, rehabilitation facilities, or nursing homes.
“Healthy days at home captures what patients can do after surgery, not just whether they survive,” said lead author Manuel Castillo-Angeles, MD, MPH, a research scientist in the Division of Trauma and Acute Care Surgery at Brigham and Women’s Hospital in Boston. “It reflects independence, recovery, and quality of life in ways traditional metrics often miss.”
Emergency general surgery includes treatment for urgent conditions such as appendicitis, bowel obstruction, and diverticulitis. Older adults face particularly high risks of postoperative complications and loss of independence following these procedures.
The study examined seven common emergency general surgery procedures. High-risk operations included laparotomy, colectomy, small bowel resection, peptic ulcer repair, and lysis of adhesions. Low-risk procedures included appendectomy and cholecystectomy.
Study Findings
- Compared with patients undergoing lower-risk procedures, those undergoing high-risk surgery spent, on average, about one month less at home during the year after surgery (308 vs. 345 days).
- Those undergoing high-risk surgery also experienced higher mortality (18.1% vs. 5.2%).
- After adjusting for other factors, older age, Black race, dementia, multiple chronic conditions, frailty, and treatment in the Midwest or South were also associated with fewer healthy days at home.
- Patients with dementia spent approximately 50 fewer days at home after surgery, and the impact of dementia was more pronounced for patients undergoing low-risk procedures than high-risk procedures. Frailty was also strongly associated with fewer healthy days at home, particularly following high-risk operations.
“Surgery itself isn’t the only risk factor for many patients. Their fitness, frailty, and overall health also matter,” said senior author Joaquim M. Havens, MD, FACS, associate professor of surgery in the Division of Trauma and Acute Care Surgery at Brigham and Women’s Hospital.
The authors said measures such as healthy days at home, along with preoperative conversations about what matters most to patients, can help surgeons, patients, and families make more informed decisions about operative and nonoperative care and recovery expectations.
“Healthy days at home are important, but every patient is different,” Dr. Havens added. “We hope patients can make surgery decisions based on their values, and that their families understand those values, so they can choose what works best for them.”
The American College of Surgeons runs two quality programs — the Emergency General Surgery Verification Program and the Geriatric Surgery Verification Program — focused on raising the standards in both the geriatric and emergency general surgery populations. A recent JACS study found that verified geriatric surgery programs screen nearly every patient for dementia, while non-accredited programs screen just half.
“For many older adults, recovery often isn’t just about surviving,” said Dr. Castillo-Angeles. “It’s about getting home and being able to stay home.”
Co-authors are Lingwei Xiang, MPH, Cheryl K. Zogg, MD, PhD, MSPH, MHS, Rachel R. Adler, ScD, Alexander J. Ordoobadi, MD, Emily Finlayson, MD, MPH, Dae H. Kim, MD, ScD, John Hsu, MD, MBA, MSCE, Samir K. Shah, MD, MPH, Clancy J. Clark, MD, and Joel S. Weissman, PhD.
The study is published as an article in press on the JACS website.
The authors report no relevant disclosures.
Support: This study was funded through a grant from the National Institutes of Health – National Institute on Aging (R01AG067507).
Citation: Castillo-Angeles M, Xiang L, Zogg C, et al. Healthy Days at Home after Emergency General Surgery: Shifting Towards Long-Term Patient-Centered Outcomes for Older Adults. Journal of the American College of Surgeons, 2026. DOI: 10.1097/XCS.0000000000001963
