Division of Vascular Surgery, University of Florida, Gainesville, Florida, USA.
Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA.
J Am Geriatr Soc. 2022 Oct;70(10):2838-2846. doi: 10.1111/jgs.17893. Epub 2022 May 30.
Patients with Alzheimer's Disease and Related Dementias (ADRD) undergoing inpatient procedures represent a population at elevated risk for adverse outcomes including postoperative complications, mortality, and discharge to a higher level of care. Outcomes may be particularly poor in patients with ADRD undergoing high-risk procedures. We sought to determine traditional (e.g., 30-day mortality) and patient-centered (e.g., discharge disposition) outcomes in patients with ADRD undergoing high-risk inpatient procedures.
This retrospective cohort study analyzed electronic health records linked to fee-for-service Medicare claims data at a tertiary care academic health system. All patients from a large multi-hospital health system undergoing high-risk inpatient procedures from October 1, 2015 to September 30, 2017 with continuous Medicare Parts A and B enrollment in the 12 months prior to and 90 days following the procedure were included.
This study included 6779 patients. 536 (7.9%) had ADRD. A multivariable analysis of outcomes demonstrated higher risks for postoperative complications (OR 1.49, 95% CI 1.23-1.81) and 90-day mortality (OR 1.44 [95% CI 1.09-1.91]) in patients with ADRD compared to those without. Patients with ADRD were more likely to be discharged to a higher level of care (OR 1.70, 95% CI 1.32-2.18) and only 37.3% of patients admitted from home were discharged to home.
Compared to those without ADRD, patients living with ADRD undergoing high-risk procedures have poor traditional and patient-centered outcomes including increased risks for 90-day mortality, postoperative complications, longer hospital lengths of stay, and discharge to a higher level of care. These data may be used by patients, their surrogates, and their physicians to help align surgical decision-making with health care goals.
患有阿尔茨海默病和相关痴呆症（ADRD）的患者在接受住院治疗时，其术后并发症、死亡率和出院至更高护理水平的风险较高。在接受高风险手术的 ADRD 患者中，结果可能特别差。我们试图确定患有 ADRD 的患者接受高风险住院手术的传统（例如 30 天死亡率）和以患者为中心的结果（例如出院处置）。
本回顾性队列研究分析了与一家三级保健学术系统的按服务收费医疗保险索赔数据相关联的电子健康记录。从 2015 年 10 月 1 日至 2017 年 9 月 30 日，在一家大型多医院医疗系统中接受高风险住院治疗的所有患者均包括在内，并且在手术前 12 个月和手术后 90 天内持续参加 Medicare 部分 A 和 B。
这项研究包括 6779 名患者。536 名（7.9％）患有 ADRD。对结果进行多变量分析表明，与没有 ADRD 的患者相比，患有 ADRD 的患者术后并发症的风险更高（OR 1.49，95％CI 1.23-1.81）和 90 天死亡率（OR 1.44 [95％CI 1.09-1.91]）。患有 ADRD 的患者更有可能被送往更高水平的护理（OR 1.70，95％CI 1.32-2.18），只有 37.3％的从家中入院的患者出院回家。
与没有 ADRD 的患者相比，患有 ADRD 且接受高风险手术的患者的传统和以患者为中心的结果较差，包括 90 天死亡率，术后并发症，住院时间延长以及向更高护理水平的转移的风险增加。这些数据可用于患者，其代理人及其医生帮助使手术决策与医疗保健目标保持一致。
