Harvard Medical School, Boston, Massachusetts, United States.
Division of Geriatrics, University of California San Francisco, San Francisco, California, United States.
J Am Geriatr Soc. 2022 Oct;70(10):2948-2957. doi: 10.1111/jgs.17928. Epub 2022 Jun 13.
Long-term functional and cognitive outcomes in nursing home residents after procedures are poorly understood. Our objective was to evaluate these outcomes after suprapubic tube (SPT) placement.
We performed a retrospective, cohort study in the nursing home setting. Participants were long-term nursing home residents who underwent SPT placement from 2014 to 2016 in the United States. SPT placements were identified in Medicare Inpatient, Outpatient, and Carrier files using International Classification of Diseases and Current Procedural Terminology codes. Residents were identified through the Minimum Data Set (MDS) 3.0 for Nursing Home Residents. MDS Activities of Daily Living (MDS-ADL) and Brief Interview for Mental Status (BIMS) scores were used to assess function and cognition, respectively. Outcomes of interest were worsening MDS-ADL and BIMS scores at 1 year postoperatively, 30-day postoperative complications, and 1-year mortality. Functional and cognitive trajectories were modeled to 1 year postoperatively using mixed-effect spline models.
From 2014 to 2016, 9647 residents with a mean age of 80.9 (SD 8.1) years underwent SPT placement. At 1 year postoperatively, 37.6% of residents died, while of survivors, 33.7% had worsening MDS-ADL and 36.2% worsened BIMS. Residents had steeper postoperative rates of functional decline compared to relatively stable preoperative trends that never recovered to baseline status. However, robustly characterizing an association between SPT placement and functional decline would require a propensity score matched cohort without SPT placement. Decline in cognitive status was not clearly associated with SPT placement, suggesting either the natural course of a vulnerable population or limitations of BIMS scores.
Outcomes important to older adults, such as functional ability and cognitive status, do not show improvement after SPT placement. These findings emphasize that this "minor" procedure should be considered with caution in this population and primarily for palliation.
在长期护理院居民中，手术后的长期功能和认知结果了解甚少。我们的目的是评估导尿术后这些结果。
我们在美国的长期护理院环境中进行了回顾性队列研究。参与者为 2014 年至 2016 年间接受导尿术的长期护理院居民。使用国际疾病分类和当前程序术语代码在医疗保险住院、门诊和承运人文件中确定导尿术的放置。居民通过护理院居民最低数据集（MDS）3.0 确定。MDS 日常生活活动（MDS-ADL）和简要精神状态访谈（BIMS）评分分别用于评估功能和认知。感兴趣的结果是术后 1 年时 MDS-ADL 和 BIMS 评分恶化、术后 30 天并发症和 1 年死亡率。使用混合效应样条模型对术后 1 年的功能和认知轨迹进行建模。
2014 年至 2016 年间，9647 名平均年龄为 80.9（SD 8.1）岁的居民接受了导尿术。术后 1 年时，37.6%的居民死亡，幸存者中 33.7%的 MDS-ADL 恶化，36.2%的 BIMS 恶化。与术前相对稳定的趋势相比，居民术后功能下降的速度更快，且从未恢复到基线状态。然而，要明确确定导尿术与功能下降之间的关联，需要一个没有接受导尿术的倾向评分匹配队列。认知状态的下降与导尿术的放置没有明显关联，这表明这可能是一个脆弱人群的自然病程，或者是 BIMS 评分的局限性。
对老年人很重要的结果，如功能能力和认知状态，在导尿术后并没有改善。这些发现强调，在该人群中，应谨慎考虑这种“小”手术，主要是为了缓解症状。
