Department of Surgery, Rutgers New Jersey Medical School, Newark, NJ.
Department of Surgery, Rutgers New Jersey Medical School, Newark, NJ.
Surgery. 2018 Feb;163(2):444-449. doi: 10.1016/j.surg.2017.09.048. Epub 2017 Dec 6.
When patients with dementia develop acute surgical abdomen, patients, surrogates, and surgeons need accurate prognostic information to facilitate goal-concordant decision making. Palliative care can assist with communication, symptom management, and family and caregiver support in this population. We aimed to characterize outcomes and patterns of palliative care utilization among patients with dementia, presenting with abdominal surgical emergency.
We retrospectively queried the National Inpatient Sample for patients aged >50 years with dementia and acute abdominal emergency who were admitted nonelectively 2009-2013, utilizing ICD-9-CM codes for dementia and surgical indication. We characterized outcomes and identified predictors of palliative care utilization.
Among 15,209 patients, in-hospital mortality was 10.2%, the nonroutine discharge rate was 67.2%, and 7.5% received palliative care. Patients treated operatively were less likely to receive palliative care than those who did not undergo operation (adjusted OR = 0.50; 95% CI 0.41-0.62). Only 6.4% of patients discharged nonroutinely received palliative care.
Patients with dementia and acute abdominal emergency have considerable in-hospital mortality, a high frequency of nonroutine discharge, and low palliative care utilization. In this group, we discovered a large gap in palliative care utilization, particularly among those treated operatively and those who are discharged nonroutinely.
当痴呆症患者出现急性外科腹痛时，患者、代理人和外科医生需要准确的预后信息，以促进目标一致的决策。姑息治疗可以在这一人群中提供沟通、症状管理以及家庭和护理人员的支持。我们旨在描述患有痴呆症、伴有腹部外科急症的患者接受姑息治疗的结局和模式。
我们回顾性地从 2009 年至 2013 年的国家住院患者样本中查询了年龄>50 岁的患有痴呆症和急性腹部急症的非选择性入院患者，使用 ICD-9-CM 代码来识别痴呆症和手术指征。我们描述了结局，并确定了姑息治疗利用的预测因素。
在 15209 名患者中，住院死亡率为 10.2%，非常规出院率为 67.2%，7.5%的患者接受了姑息治疗。与未接受手术的患者相比，接受手术治疗的患者接受姑息治疗的可能性较低（调整后的 OR=0.50；95%CI 0.41-0.62）。只有 6.4%的非常规出院患者接受了姑息治疗。
患有痴呆症和急性腹部急症的患者住院死亡率较高，非常规出院率较高，姑息治疗利用率较低。在这组患者中，我们发现姑息治疗的利用率存在很大差距，特别是在接受手术治疗和非常规出院的患者中。
