Researchers found that the group needing inpatient rehab tended to be older, needed more assistance, had lower cognitive function, had fewer stairs at home, and had a longer length of stay. There were no differences according to gender, donor site, tube feeds, or use of assistive devices.
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August 2023A lack of family assistance made a patient 4.5 times more likely to be discharged to inpatient rehab compared to those not needing this assistance, Chandna noted. Needing assistance at baseline for activities of daily living made a patient 3.9 times more likely to be discharged to inpatient rehab compared to those not needing this kind of assistance. Other predictors included baseline cognitive dysfunction (2.4 times more likely), age 80 or older (2.3 times), and change in weight-bearing status following the surgery (2.2 times).
Chandna said the findings confirmed researchers’ expectations that these factors could help predict patients’ path of care. “Our hypothesis is that these metrics are predictive of head and neck free flap discharge destination,” she said. “And, ultimately, we would like to prescreen and counsel patients and families prior to free flap regarding their expected postop course.”
She noted that the research team hopes to continue examining factors related to discharge destination. “In the future,” she said, “we would hope to expand our sample size, look at a greater distribution of race, gender, different types of free flaps, to hopefully make a revised head and neck free-flap, pre-procedure checklist to become a predictive algorithm.”
Index Helps Predict Complications in Geriatric Tracheostomy
Nutritional risk assessed with the Geriatric Nutritional Risk Index (GNRI) was predictive of outcomes after a tracheostomy in the geriatric population, according to a new study. The findings suggest the index could be a valuable tool when performing this procedure, said Afash Haleem, BA, a medical student and researcher at Rutgers New Jersey Medical School in Newark.
[GNRI scores] can be quite useful for clinicians when looking at patients who will undergo a planned tracheostomy—patients and their families can be appropriately counseled. —Afash Haleem, BA
Tracheostomy, commonly used for prolonged mechanical ventilation due to acute respiratory failure, neuromuscular disease, aspiration, or other issues, has an incidence of about 100,000 per year. “These patients undergo a variety of different complications, including surgical site infections, hemorrhage, and pneumothorax,” Haleem said. “Unfortunately, malnutrition is a commonly discussed preoperative comorbidity for patients undergoing a variety of different surgical procedures.” There is no universal definition of malnutrition, however, with a variety of definitions in the literature and, subsequently, a wide range of prevalence estimates in the geriatric population—between 20% and 60%, he said.