ImportanceMajor surgery sometimes involves long recovery or even permanent institutionalization. Little is known about long-term trajectories of postoperative recovery, as surgical registries are limited to 30-day outcomes and care can occur across various institutions.ObjectiveTo characterize long-term postoperative recovery trajectories.Design, Setting, and ParticipantsThis retrospective cohort study used Veterans Affairs (VA) Surgical Quality Improvement Program data (2016 through 2019) linked to the Residential History File, combining data from the VA, Medicare/Medicaid, and other sources to capture most health care utilization by days. Patients were divided into younger (younger than 65 years) or older (65 years or older) subgroups, as Medicare eligibility is age dependent. Latent-class, group-based trajectory models were developed for each group. These data were analyzed from February 2023 through August 2024.ExposureSurgical care in VA hospitals.Main Outcomes and MeasuresDays elsewhere than home (DEH) were counted in 30-day periods for 275 days presurgery and 365 days postsurgery.ResultsA 5-trajectory solution was optimal and visually similar for both age groups (cases: 179 879 younger [mean age (SD) 51.2 (10.8) years; most were male [154 542 (83.0%)] and 198 803 older [mean (SD) age, 72.2 (6.0) years; 187 996 were male (97.6%)]). Most cases were in trajectories 1 and 2 (T1 and T2). T1 cases returned home within 30 days (younger, 74.0%; older, 54.2%), while T2 described delayed recovery within 30 to 60 days (younger, 21.6%; older, 35.5%). Trajectory 3 (T3) and trajectory 4 (T4) were similar for the first 30 days postsurgery, but subsequently separated with T3 representing protracted recovery of 6 months or longer (younger, 2.7%; older, 3.8%) and T4 indicating long-term loss of independence (younger, 1.3%; older, 5.2%). Few (trajectory 5) were chronically dependent, with 20 to 30 DEH per month before and after surgery (younger, 0.4%; older, 1.3%).Conclusions and RelevanceIn this study, trajectory models demonstrated clinically meaningful differences in postoperative recovery that should inform surgical decision-making. Registries should include longer-term outcomes to enable future research to distinguish patients prone to long-term loss of independence vs protracted, but meaningful recovery.

中文翻译：

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年轻和年长退伍军人术后恢复的长期轨迹


重要性大手术有时涉及长时间恢复甚至永久住院。人们对术后恢复的长期轨迹知之甚少，因为手术登记仅限于 30 天的结果，并且护理可以在各种机构进行。目的描述术后长期恢复轨迹。设计、设置和参与者这项回顾性队列研究使用了与住宅历史文件相关的退伍军人事务部 （VA） 手术质量改进计划数据（2016 年至 2019 年），结合了来自 VA、Medicare/Medicaid 和其他来源的数据，以捕获大多数医疗保健利用率按天计算。患者被分为较年轻 （小于 65 岁） 或较大 （65 岁或以上） 亚组，因为 Medicare 资格与年龄有关。为每个组开发了潜伏类、基于组的轨迹模型。这些数据是从 2023 年 2 月到 2024 年 8 月进行的分析的。主要结局和测量 以 30 天为周期计算术前 275 天和术后 365 天的 Days than home （DEH）。结果两个年龄组的 5 轨迹解决方案是最佳的，并且在视觉上相似 （病例：179 879 年轻 [平均年龄 （SD） 51.2 （10.8） 岁;大多数是男性 [154 542 （83.0%）] 和 198 803 年年龄 [平均 （SD） 年龄，72.2 （6.0） 岁;187 996 是男性 （97.6%）]）。大多数病例位于轨迹 1 和 2 （T1 和 T2）。T1 病例在 30 天内返回家中 （年轻 74.0%;老年 54.2%），而 T2 病例在 30 至 60 天内延迟恢复 （年轻 21.6%;老年 35.5%）。术后前 30 天的轨迹 3 （T3） 和轨迹 4 （T4） 相似，但随后分开，T3 代表 6 个月或更长时间的漫长恢复 （年轻，2.7%;年龄较大，3.8%）和 T4 表示长期独立性丧失 （年轻 1.3%;老年 5.2%）。很少 （轨迹 5） 是慢性依赖性的，手术前后每月 20 至 30 DEH （年轻，0.4%;老年，1.3%）。结论和相关性在这项研究中，轨迹模型证明了术后恢复方面具有临床意义的差异，这应该为手术决策提供信息。登记处应包括长期结局，以便未来的研究能够区分容易长期丧失独立性的患者与长期但有意义的恢复。