Post-Operative Care and Rehabilitation Overview

1. CENTER FOR SURGERY
AND PUBLIC HEALTH
Post-operative Care and
Rehabilitation
Elizabeth Lilley, MD, MPH
General surgery resident, Rutgers – Robert Wood Johnson
Medical School,
New Brunswick, NJ
Postdoctoral fellow, Center for Surgery and Public Health at
Brigham and Women’s Hospital, Boston, MA
N I H - A C S S Y M P O S I U M O N S U R G I C A L D I S PA R I T I E S R E S E A R C H

2. CENTER FOR SURGERY
AND PUBLIC HEALTH
• Surgical care occurs outside
the operating room
• Hospital and provider
factors are important
• Post-discharge care and
rehabilitation

3. CENTER FOR SURGERY
AND PUBLIC HEALTH
Background
• Access to rehabilitation
• Decreased post-acute care services after stroke1,
MI2
• Decreased rehab after trauma3
• Decreased utilization of TBI rehab4,5
• Less intensive rehab after joint surgery6,7
• Outcomes of rehabilitation
• Lower functional improvement among minorities
and men8,9

4. CENTER FOR SURGERY
AND PUBLIC HEALTH
Race/Ethnicity Disparities
• Timing of care and follow-up
• Black/Hispanic breast cancer patients higher risk for late
initiation or incomplete chemotherapy10
• Blacks less likely to receive post-treatment surveillance for
colorectal cancer11
• Black/Hispanic higher risk early graft failure after bypass12
• Long-term functional outcomes
• Longitudinal evidence of mental health disparities after TBI13
• Racial/ethnic disparities in employment after SCI14
• Palliative/EOL care
• Ethnic and racial differences in CPR and use of LST after major
surgery15

5. CENTER FOR SURGERY
AND PUBLIC HEALTH
Known Factors
- Poverty16,17
-Education level17
 Access / duration
 Quality
- Health related beliefs,
practices, and risks18,19
- Language20
- Financial barriers (health
insurance)18,19,21,22,23
- Non-financial barriers (lack of
awareness, location, provider
biases)18,19,20
24,25
26
27
Health
Disparities

6. CENTER FOR SURGERY
AND PUBLIC HEALTH
Gaps in Literature
• Access and utilization of rehab and supportive care
services
– Physiotherapy
– Wound care
– Medication access / compliance
• Longitudinal data on functional outcomes and quality
of life
• Post-discharge follow-up with surgeon / loss to
follow-up

7. CENTER FOR SURGERY
AND PUBLIC HEALTH
Future Directions
• Describe disparities in recovery and outcomes
• Engage patients and families
• Identify targets for improving access/quality
• Health education and awareness for post-op
care
– Explore new technologies

8. CENTER FOR SURGERY
AND PUBLIC HEALTH
Conclusion
• Importance of rehabilitation and recovery
• Disparities exist in access, experience, and follow-
up
• Frame research agenda
– Prioritize research targets
– Increase diversity in research studies
– More diversity among healthcare providers
– Identify measurable outcomes
– Longitudinal outcome measurement

9. CENTER FOR SURGERY
AND PUBLIC HEALTH
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2. Aragam KG, Moscucci M, Smith DE, et al. Trends and disparities in referral to cardiac rehabilitation after percutaneous coronary intervention. Am Heart J. Mar 2011;161(3):544-551 e542.
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