Post-Acute Care After Surgery: A New Hospital Quality Metric?

With discharge to post-acute care often seen as an unanticipated and costly surgical outcome, researchers are proposing that discharge to post-acute care could be used as a benchmarking metric in care for older adults.

Because discharge to post-acute care can add more than $5,000 to care costs and is associated with worse outcomes for older patients, a study published in the Journal of the American College of Surgeons (JACS) suggests it may be a valuable benchmark to help hospitals evaluate how they are serving older adult surgical patients. 

“The research shows that some discharges to a skilled nursing facility or other post-acute care facility postoperatively are preventable,” said lead study author Sarah L. Remer, M.D., a research fellow with the Division of Research and Optimal Patient Care at the American College of Surgeons (ACS), in a statement. “By utilizing this benchmark to evaluate performance compared to peers, hospitals can focus on some of the interventions that can prevent discharge to a post-acute care facility,” added Remer, who is also a general surgery resident at Loyola University Medical Center in Maywood, Ill.

“Research shows that prehabilitation and similar perioperative mobility programs can prevent discharge to a non-home facility; investing time and effort in these kinds of programs to send patients home after surgery instead of sending them to a non-home facility may be worthwhile,” she said.  

The study used data from hospitals participating in the ACS National Surgical Quality Improvement Program (NSQIP), a data registry designed to improve hospital-wide quality across all surgical departments. The analysis included 494 hospitals and 277,160 patients aged 65 years or older. The researchers used a model to identify high and low outliers among the studied hospitals based on the odds ratio of discharging patients to post-acute care facilities. 

Key findings 
• 11.2% (30,907) of older adult patients were discharged to a post-acute care facility, most of whom were inpatient cases.  
• 84 hospitals (17%) were low outliers, meaning their rate of discharge to post-acute care facilities was below the norm, 119 (24.1%) were high outliers, and almost 60% of hospitals performed as expected. A clinically significant number of hospitals remained high and low outliers. 
• When the 25% of patients considered at highest risk for discharge to a post-acute care facility were separated from the rest of the study population, 32.9% were discharged to a post-acute care facility.  

Presented at the American Geriatrics Society 2025 annual meeting in Chicago, the study states that using discharge to an acute-care facility as a benchmark could allow surgeons and hospital administrators to evaluate their institution’s performance and identify possible areas for improvement, drawing on previously published evidence suggesting that NSQIP benchmarking, along with rigorous data analysis and quality improvement initiatives, improves patient care. 

Remer added that hospitals can also adopt quality improvement initiatives such as the ACS Geriatric Surgery Verification program or similar interventions to decrease the number of patients discharged to post-acute care.