Using latent class analysis to identify subgroups of postoperative older adults

Objective: Identify subgroups of postoperative older adults using a latent class analysis (LCA) of routinely collected patient data, including preoperative frailty and postoperative mobility. Methods: Retrospective analysis of routinely collected data for adults 65 years and older (N=2,036) admitted to the hospital following surgery at our institution. We utilized LCA to identify patient subgroups based on routinely collected measures of frailty, mobility, activities of daily living, and general health status. We compared hospital outcomes between the identified groups, including extended length of stay (LOS) (>0.5 SD beyond mean LOS by surgical category), discharge disposition (i.e., home versus non-home discharge), and utilization (weekly visit frequency) of physical therapy (PT) and occupational therapy (OT). Results: We identified 3 subgroups of patients that we labeled Low Frailty-High Mobility (LF-HM), High Frailty-Low Mobility (HF-LM), and Low Frailty-Low Mobility (LF-LM), representing 15.3%, 27.6%, and 57.1% of the cohort, respectively. Discharge to home was highest among the LF-HM group (99%), followed by LF-LM (96%), and HF-LM (77%). Extended LOS was most common among the HF-LM group (27%), followed by LF-LM (18%), and LF-HM (6%). PT and OT visit frequencies were highest in the HF-LM group followed by the LF-LM and LF-HM groups. Conclusions: This study identified 3 subgroups of postoperative older adults using routinely collected patient data. These groups may help to explain variations in hospital outcomes that have not been adequately explained using measures of preoperative or postoperative measures alone. These results may be useful in developing tailored postoperative care for older adults.