Challenges of Care Transition From Hospital to Home for Older Colorectal Surgery Patients: Surgeons’ Perspectives

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Objective: Postdischarge transitions from the hospital to home in older (≥65 years) colorectal surgery patients have a high risk of medication errors, complications, and worsening of existing conditions. Up to 14% are readmitted within 30 days, costing ~$180 million annually. The anticipated 50% increase in colorectal cancer surgeries in older adults by 2040 necessitates an improvement in care transitions and outcomes. Methods: We conducted semi-structured qualitative interviews with 10 surgeons from 8 US health systems to inform the design of a multicomponent care transition model. We selected participants through stratified purposive sampling based on experience with older surgical patients and/or leadership roles. Consolidated Criteria for Reporting Qualitative Studies guidelines were followed, and a detailed line-by-line editing and organizing style was used to analyze transcripts. Results: The interviews identified challenges in care transitions and potential solutions, and 4 themes emerged: (1) Discharge planning should start before surgery and incorporate preoperative geriatrics evaluation and planning; (2) Coordinated communication and collaboration among multidisciplinary care teams are necessary but often lacking; (3) Educating older surgical patients and their care partners and involving them in care decisions is needed for successful management of care responsibilities after discharge; and (4) The complex and fragmented healthcare system creates care challenges postdischarge. Conclusions: Discharge planning that begins preoperatively, integrates geriatrics domains, ensures timely and coordinated interdisciplinary communication postdischarge, and emphasizes patient and family education is essential to improve care transitions in older colorectal surgery patients. A multilevel care transition model incorporating these elements may enhance outcomes and reduce readmissions.

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