Discharge disposition after surgery can be considered a proxy for functional and cognitive outcomes. Functional limitations in the perioperative period often prevent older patients from being discharged to home after surgery. The very elderly are much more likely to require admission to a skilled care facility after surgery than their younger counterparts. In Michigan, 20% of elderly patients are discharged to a skilled care facility after cardiac surgery. Of those discharged to home, more than 30% are readmitted to the hospital or a skilled care facility. In the 2003 Nationwide Inpatient Sample database, age was associated with discharge to an extended care facility (i.e., rehab, nursing home, or another hospital) after CABG, valve replacement, hip replacement, colon resection, and cystectomy (Figure 37-2). Patients undergoing hip replacement in all age groups had a high rate of discharge to an extended care facility, but the likelihood of discharge to a facility increased dramatically with age, from 28% for patients younger than 65 years to 87% for patients older than 85 years. Over half of patients aged 85 years and older undergoing cardiac procedures were not discharged to home after surgery. Rates of discharge to a facility were nearly as high after colectomy and cystectomy in the oldest patients. This information is important for several reasons. First, elderly patients and their families need to have realistic expectations about recovery after major surgery when deciding whether to undergo an elective operation. Second, once the decision for surgery has been made, patients and caregivers need to anticipate the longitudinal needs of elderly patients in the recovery period.