# Beyond 30-Days: Patient-Oriented Outcomes Among Older Adults After Emergency General Surgery

> **NIH NIH K76** · BRIGHAM AND WOMEN'S HOSPITAL · 2020 · $110,759

## Abstract

Project Summary/Abstract
Emergency General Surgery (EGS) procedures are among the most morbid and common operations in older
adults. Postoperative mortality risk in older EGS patients is 3 times higher than for older patients after elective
surgery, and 2-7 times higher than for younger EGS patients. Moreover, up to half of older EGS patients
experience postoperative complications and most are discharged to nursing homes. With demographic shifts,
the rate of EGS in older adults is expected to increase. However, outcomes that are particularly relevant to
older EGS patients such as survival beyond 30-days, functional and cognitive trajectories, quality of life, and
palliative care needs are unknown. This proposal addresses these knowledge gaps utilizing multiple data
sources and complementary methodologies. First, Medicare Claims will be used to examine 12-month survival
and health care utilization in a national cohort. Second, primary prospective data will be collected from a cohort
of older EGS patients and their proxies to examine key outcomes unavailable in secondary datasets including
symptom burden, functional and cognitive status, quality of life, advance care planning, and quality of end-of-
life care. Third, qualitative analyses of semi-structured interviews with patients and proxies will be done to
obtain a richer understanding about their lived experience. The Specific Aims are: 1. To use National
Medicare Claims to describe 12-month outcomes including survival, post-acute nursing home use,
rehospitalization, and hospice use in older EGS patients (N=650,157), identify factors associated with better
outcomes, and to compare these outcomes in a propensity-matched cohort of patients emergently hospitalized
for three common medical conditions (pneumonia, congestive heart failure, and myocardial infarction,
N=2,013,861); 2. To prospectively follow a cohort of older EGS patients (n~150) and their proxies (n~150) up
to 12 months after surgery, to identify modifiable factors associated with fewer hospital transfers, better quality
of life, and better end-of-life care; and, 3. To use a phenomenological approach to qualitatively analyze semi-
structured interviews with patients (N=20) and proxies (N=20) from the cohort in Aim 2, to obtain an in-depth
understanding of opportunities to improve post-surgical care in the following domains: quality of provider
communication, advance care planning, symptom management, care transitions, and proxy experience.
IMPACT: This work represents key steps in improving surgical care for older EGS patients by directly informing
individual clinical decisions, setting expectations for recovery, helping to plan subsequent heath care needs,
and revealing targets to improve surgical care delivery and palliative care for these patients. Finally, the work
will establish the applicant as one of the few surgical health services researchers with expertise in aging and
palliative care, and will prepare her to become an indepe...

## Key facts

- **NIH application ID:** 9927967
- **Project number:** 5K76AG054859-05
- **Recipient organization:** BRIGHAM AND WOMEN'S HOSPITAL
- **Principal Investigator:** Zara R Cooper
- **Activity code:** K76 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $110,759
- **Award type:** 5
- **Project period:** 2016-09-15 → 2021-12-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9927967

## Citation

> US National Institutes of Health, RePORTER application 9927967, Beyond 30-Days: Patient-Oriented Outcomes Among Older Adults After Emergency General Surgery (5K76AG054859-05). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/9927967. Licensed CC0.

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