Perspectives on Home Time and Its Association With Quality of Life After Inpatient Surgery Among US Veterans
Authors: Shipra Arya, Ashley H. Langston, Rui Chen, Marzena Sasnal, Elizabeth L. George, Aditi Kashikar, Nicolas B. Barreto, Amber W. Trickey, Arden M. Morris
Journal: JAMA Network Open (2022)

<h3>Importance</h3> Home time, defined as time spent at home after hospital discharge, is emerging as a novel, patient-oriented outcome in stroke recovery and end-of-life care. Longer home time is associated with lower mortality and higher patient satisfaction. However, a knowledge gap exists in the measurement and understanding of home time in the population undergoing surgery. <h3>Objectives</h3> To examine the association between postoperative home time and quality of life (QoL), functional status, and decisional regret and to identify themes regarding the meaning of time spent at home after surgery. <h3>Design, Setting, and Participants</h3> This mixed-methods study including a survey and qualitative interviews used an explanatory sequential design involving 152 quantitative surveys followed by in-depth interviews with 12 participants from February 26, 2020, to December 17, 2020. US veterans older than 65 years who underwent inpatient surgery at a single-center veterans hospital within the prior 6 to 12 months were studied. <h3>Exposures</h3> Quality of life, measured by the Veterans RAND 12-item Health Survey and 19-item Control, Autonomy, Self-realization, and Pleasure scale; functional status, measured by activities of daily living (ADL) and instrumental ADL scales; and regret, measured by the Decision Regret Scale. <h3>Main Outcomes and Measures</h3> Home time, standardized as percentage of total time spent at home from the time of surgery to the time of survey administration. Associations between home time and QoL, function, and decisional regret in the survey data were analyzed using Spearman correlation in the overall cohort and in operative stress score subcohorts (1-2 [low] vs 3-5 [high]) in a stratified analysis. The 12 semistructured interviews were analyzed to elicit patients' perspectives on home time in postoperative recovery. Qualitative data were coded and analyzed using content and thematic analysis and integrated with quantitative data in joint displays. <h3>Results</h3> A total of 152 patients (mean [SD] age, 72.3 [4.4] years; 146 [96.0%] male) were surveyed, and 12 patients (mean [SD] age, 72.3 [4.8] years; 11 [91.7%] male) were interviewed. The median time to survey completion was 307 days (IQR, 265-344 days). The median home time was 97.8% (IQR, 94.6%-98.6%; range, 22.2%-99.5%). Increased home time was associated with better physical health–related QoL in the Veterans RAND 12-item Health Survey (<i>r</i> = 0.33; 95% CI, 0.18-0.47;<i>P</i> &lt; .001) and higher ADL scores (<i>r</i> = 0.21; 95% CI, 0.06-0.36;<i>P</i> = .008) and instrumental ADL functional scores (<i>r</i> = 0.21; 95% CI, 0.04-0.37;<i>P</i> = .009). Decisional regret was inversely associated with home time in only the high operative stress score subcohort (<i>r</i> = −0.22; 95% CI, −0.47 to −0.04;<i>P</i> = .047). Home was perceived as a safe and familiar environment that accelerated recovery through nurturing support of loved ones. <h3>Conclusions and Relevance</h3> In this mixed-methods study including a survey and qualitative interviews, increased home time in the first year after major surgery was associated with improved daily function and physical QoL among US veterans. Interviewees considered the transition to home to be an indicator of recovery, suggesting that home time may be a promising, patient-oriented quality outcome measure for surgical recovery that warrants further study.