1) to evaluate whether and to what extent differences in hospital nursing resources (i.e., patient-to-nurse staffing ratios, work environment) are associated withoutcomes of older adult surgical patients with and without prolonged surgical time, and
2) to determine whether the effects of hospital nursing resources on older adult surgical patient outcomes are conditional on surgical time.
More older adults in the United States are undergoing inpatient surgery than ever before. Older age is a risk factor for greater morbidity and mortality following surgery; therefore, improving the surgical care and outcomes of older adults warrants attention. In this proposal, we focus on one concerning adverse surgical event which is particularly threatening to the postoperative recovery of older adults— prolonged surgical time. Prolonged surgical time is associated with complications including a greater risk of death, longer stays in the hospital, and other poor outcomes including venous thromboembolism, anemia, and sepsis. The current literature on outcomes of older adults with prolonged surgical time is limited to descriptive research and offers no evidence about prevention or early intervention of complications should they occur. The proposed study seeks to examine the outcomes of older adult surgical patients that experience prolonged surgical time and modifiable nursing resources within hospitals. Decades of research has shown that when nurses at the bedside
are adequately staffed and practice in environments that allow for nurse autonomy and teamwork with physician colleagues, patients are more likely to have favorable postoperative outcomes. The benefits of these good nursing resources are most pronounced among patients with the highest clinical risk, which lends credence to our hypothesis that favorable staffing ratios and supportive work environments will be especially beneficial to older adults with prolonged surgical time. The proposed study addresses the following aims: 1) to evaluate whether and to what extent differences in hospital nursing resources (i.e., patient-to-nurse staffing ratios, work environment) are associated with outcomes of older adult surgical patients with and without prolonged surgical time and 2) to determine whether the effects of hospital nursing resources on older adult surgical patient outcomes are conditional on surgical time. This study will use multiple linked secondary data sources including patient data from the Centers from Medicare and Medicaid Services (CMS), hospital data about nursing resources from the RN4CAST survey of nurses, and data of hospital structural characteristics from the American Hospital Association Annual Survey. Datasets will be linked by hospital identifiers common to all datasets. We anticipate the patient sample will include 800,000 older adult surgical patients, 65 years old or older, which will be representative of approximately 160 surgical procedures and approximately 500 hospitals. Findings obtained from this study will support a burgeoning program of research to inform targeted interventions for improving the care and outcomes of high-risk older adult surgical patients.