# Standard-of-care vs expert-recommended discharge destinations for geriatric surgical inpatients: a prospective observational cohort study

## TL;DR

This study finds that aligning discharge plans for older surgical patients with geriatric expert recommendations can improve outcomes and reduce readmissions.

## Contribution

The novel contribution is identifying a 27% discrepancy between standard discharge decisions and geriatrician recommendations, and linking this mismatch to worse patient outcomes.

## Key findings

- A 27% discrepancy was found between standard discharge decisions and geriatric expert recommendations.
- Mismatch was associated with higher frailty, functional decline, and increased readmission rates.
- Aligning discharge decisions with geriatric expertise may improve outcomes and reduce readmissions.

## Abstract

Discharge planning is important to ensure optimal postoperative outcomes for older surgical inpatients. As part of the Supporting SURgery with GEriatric co-management and AI (SURGE-Ahead) project, this study investigates how congruence between standard of care discharge decisions and geriatric expert recommendations affects functional outcomes in older surgical inpatients.

A prospective observational cohort study was conducted across three surgical departments at Ulm University Medical Center (Trauma, Visceral, and Urology). Patients aged 70 years or older with an Identification of Seniors at Risk score ≥ 2 were enrolled. The congruence between the standard of care discharge decisions (actual discharge destination) and recommendations made by expert geriatricians (unknown to clinicians) was determined across four discharge options: home, acute geriatric care unit, post-acute rehabilitation facility, or nursing home. Multivariable logistic regression was employed to examine how the match between recommended and actual discharge destinations related to functional outcomes and readmission rates post-discharge.

Among the 169 participants (mean age 80.5 ± 6.3 years, 58.6% female), a discrepancy of 27% was observed between the standard of care and expert recommendations. Patients with discharge decisions incongruent to geriatric expert recommendations showed higher frailty scores, more dependence in activities of daily living, and reduced mobility pre-operatively. Mismatch between expert recommendations and standard of care was associated with a decline in Barthel Index and Charité Mobility Index scores, and higher 3-month readmission rates.

Optimizing discharge destinations may prevent functional decline and reduce readmissions. Closing the gap between standard of care discharge decisions and geriatric expert recommendations could improve functional outcomes for older surgical inpatients.

German clinical trials registry (DRKS00030684), registered on 21st November 2022.

The online version contains supplementary material available at 10.1007/s41999-025-01382-x.

Assessment of the congruence between standard discharge decisions and geriatric expert recommendations in older surgical inpatients.

A 27% discrepancy was observed between standard discharge decisions and geriatrician recommendations, with incongruence associated with higher frailty, greater pre-operative functional limitations, and poorer post-discharge functional outcomes and readmission rates.

Aligning discharge decisions with geriatric expertise may improve functional outcomes and reduce readmissions in older surgical patients.

The online version contains supplementary material available at 10.1007/s41999-025-01382-x.