Division of Vascular and Endovascular Surgery and Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia, Charlottesville, Va.
Division of Vascular and Endovascular Surgery and Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia, Charlottesville, Va.
J Vasc Surg. 2018 Oct;68(4):1203-1208. doi: 10.1016/j.jvs.2018.01.032. Epub 2018 Mar 30.
Dementia represents a major risk factor for medical complications and has been linked to higher rates of complication after surgery. Given the systemic nature of vascular disease, medical comorbidities significantly increase cost and complications after vascular surgery. We hypothesize that the presence of dementia is an independent predictor of increased postoperative complications and higher health care costs after vascular surgery.
The Vascular Quality Initiative database was queried for all patients undergoing vascular surgery at a single academic medical center from 2012 to 2017. All modules were included (open abdominal aortic aneurysm, suprainguinal bypass, lower extremity bypass, amputation, carotid endarterectomy, endovascular aortic aneurysm repair, thoracic endovascular aortic aneurysm repair, and peripheral endovascular intervention). An institutional clinical data repository was queried to identify patients with International Classification of Diseases, Ninth Revision diagnosis codes for dementia as well as total hospital cost and long-term survival using Social Security records from the Virginia Department of Health. Hierarchical logistic and linear regression models were fit to assess risk-adjusted predictors of any complication and inflation-adjusted cost. Kaplan-Meier and Cox proportional hazards models were used for survival analysis.
A total of 2318 patients underwent vascular surgery and were captured by the Vascular Quality Initiative during the past 5 years, with 88 (3.8%) having a diagnosis of dementia. Patients with dementia were older and had higher rates of medical comorbidities, and the most common procedure was major amputation. In addition, dementia patients had a significantly higher rate of any complication (52% vs 16%; P < .0001) and increased 90-day mortality (14% vs 4.8%; P = .0002). Furthermore, dementia was associated with significant resource utilization, including preoperative length of stay (LOS), postoperative LOS, intensive care unit LOS, and inflation-adjusted total hospital cost (all P < .0001). Hierarchical modeling demonstrated that dementia was the strongest preoperative predictor for any complication (odds ratio, 8.64; P < .0001) and had the largest risk-adjusted impact on total hospital cost ($22,069; P < .0001). Finally, survival analysis demonstrated that dementia is independently associated with reduced survival after vascular surgery (hazard ratio, 1.37; P = .018).
This study demonstrated that dementia is one of the strongest predictors of any complication and increased hospital cost after vascular surgery. Given the high risk of clinical and financial maladies, patients with dementia should be carefully considered and counseled before undergoing vascular surgery.
痴呆是医疗并发症的主要危险因素之一，并与手术后并发症发生率升高有关。鉴于血管疾病的系统性，合并症显著增加了血管手术后的成本和并发症。我们假设痴呆的存在是术后并发症增加和血管手术后医疗保健费用增加的独立预测因素。
从 2012 年至 2017 年，在一个学术医疗中心对接受血管手术的所有患者进行了血管质量倡议数据库查询。纳入了所有模块（开放性腹主动脉瘤、下肢旁路、截肢、颈动脉内膜切除术、血管内腹主动脉瘤修复、胸主动脉血管内修复和外周血管内介入）。通过弗吉尼亚州卫生部的社会保障记录，从机构临床数据存储库中查询国际疾病分类，第九版诊断代码为痴呆的患者以及总住院费用和长期生存情况。使用分层逻辑回归和线性回归模型来评估任何并发症和通胀调整成本的风险调整预测因素。Kaplan-Meier 和 Cox 比例风险模型用于生存分析。
在过去 5 年中，共有 2318 例患者接受了血管手术，并被血管质量倡议捕获，其中 88 例（3.8%）被诊断为痴呆。痴呆患者年龄较大，合并症发生率较高，最常见的手术是大截肢。此外，痴呆患者的任何并发症发生率显著更高（52%比 16%；P<0.0001），90 天死亡率也显著升高（14%比 4.8%；P=0.0002）。此外，痴呆与显著的资源利用有关，包括术前住院时间（LOS）、术后 LOS、重症监护病房 LOS 和通胀调整后的总住院费用（均 P<0.0001）。分层模型表明，痴呆是任何并发症的最强术前预测因素（优势比，8.64；P<0.0001），对总住院费用的风险调整影响最大（22069 美元；P<0.0001）。最后，生存分析表明，痴呆与血管手术后的生存降低独立相关（风险比，1.37；P=0.018）。
这项研究表明，痴呆是血管手术后任何并发症和住院费用增加的最强预测因素之一。鉴于临床和财务疾病的高风险，在进行血管手术之前，应仔细考虑并告知痴呆患者。
