Postoperative Outcomes and Recovery Trajectory among Patients with Gastrointestinal Cancer Undergoing Emergency General Surgery

BACKGROUND: For older adults with gastrointestinal cancer undergoing emergency general surgery, perioperative metrics do not capture prolonged institutional dependence after operation. We characterized 12-month days elsewhere than home (DEH) recovery trajectories and identified factors associated with protracted recovery (PR) and sustained high DEH (SH-DEH). STUDY DESIGN: We performed a retrospective cohort study using Surveillance, Epidemiology, and End Results-Medicare (2005 to 2019) of beneficiaries aged 66 years and older with gastrointestinal cancer undergoing emergency general surgery. Monthly DEH during the 12 postoperative months was modeled using group-based trajectory modeling. Modified Poisson regression identified preoperative and postoperative factors associated with PR and SH-DEH. RESULTS: Among 15,398 patients, 6,852 were men, 8,546 were women, and 11,917 (77.4%) were White. Four trajectories were identified: routine recovery (42.5%; n = 6,543), chronically dependent (37.1%; n = 5,719), PR (7.2%; n = 1,109), and SH-DEH (13.2%; n = 2,027). SH-DEH was associated with stage IV disease (adjusted relative risk [aRR] 2.39, 95% CI 2.07 to 2.76), frailty (aRR 2.58, 95% CI 2.09 to 3.19), Charlson Comorbidity Index greater than 2 (aRR 1.37, 95% CI 1.24 to 1.53), and intrahepatic cholangiocarcinoma (aRR 3.52, 95% CI 2.58 to 4.82). PR was associated with stage IV disease (aRR 1.92, 95% CI 1.59 to 2.32), a Charlson Comorbidity Index greater than 2 (aRR 1.79, 95% CI 1.55 to 2.08), claims-based frailty risk (aRR 4.50, 95% CI 3.68 to 5.52), and pancreatic cancer (aRR 2.52, 95% CI 2.09 to 3.04; all p < 0.001). Major postoperative complications, prolonged length of stay, and ICU admission increased the likelihood of both PR and SH-DEH. Model discrimination ranged from 0.74 to 0.84. CONCLUSIONS: Older adults with gastrointestinal cancer undergoing emergency general surgery demonstrated distinct DEH recovery trajectories. Frailty, advanced disease, comorbidity, and postoperative complications identified patients at risk for prolonged recovery or sustained institutional dependence.