Colley Alexis, Finlayson Emily, Zhao Shoujun, Boscardin John, Suskind Anne
Department of Surgery, University of California, San Francisco, San Francisco, California, USA.
Department of Urology, University of California, San Francisco, San Francisco, California, USA.
Colorectal Dis. 2023 Feb;25(2):298-304. doi: 10.1111/codi.16334. Epub 2022 Sep 23.
To evaluate 30-day complications and 1-year mortality for older adults undergoing haemorrhoid surgery.
This retrospective cohort study evaluated older adults (age 66+) undergoing haemorrhoid surgery using Medicare claims and the minimum data set (MDS). Long-stay nursing home residents were identified, and propensity score matched to community-dwelling older adults. Generalized estimating equation models were created to determine the adjusted relative risk of 30-day complications, length of stay (LOS), and 1-year mortality. Among nursing home residents, functional and cognitive status were evaluated using the MDS-activities of daily living (ADL) score and the Brief Instrument of Mental Status. Faecal continence status was evaluated among a subset of nursing home residents.
A total of 3664 subjects underwent haemorrhoid surgery and were included in the analyses. Nursing home residents were at significantly higher risk for 30-day complications (52.3% vs. 32.9%, aRR 1.6 [95% CI: 1.5-1.7], p < 0.001), and 1-year mortality (24.9% vs. 16.1%, aRR 1.6 [95% CI: 1.3-1.8], p < 0.001). Functional and mental status showed an inflection point of decline around the time of the procedure, which did not recover to the baseline trajectory in the following year. Additionally, a subset of nursing home residents demonstrated worsening faecal incontinence.
This study demonstrated high rates of 30-day complications and 1-year mortality among all older adults (yet significantly worse among nursing home residents). Ultimately, primary care providers and surgeons should carefully weigh the potential harms of haemorrhoid surgery in older adults living in a nursing home.
评估老年患者行痔疮手术后30天并发症及1年死亡率。
这项回顾性队列研究利用医疗保险理赔数据和最小数据集（MDS）评估了行痔疮手术的老年患者（年龄≥66岁）。识别出长期入住疗养院的居民，并与社区居住的老年人进行倾向得分匹配。建立广义估计方程模型以确定30天并发症、住院时间（LOS）和1年死亡率的调整后相对风险。在疗养院居民中，使用MDS日常生活活动（ADL）评分和简易精神状态量表评估功能和认知状态。在一部分疗养院居民中评估大便失禁状态。
共有3664名受试者接受了痔疮手术并纳入分析。疗养院居民发生30天并发症的风险显著更高（52.3%对32.9%，调整后相对风险1.6[95%置信区间：1.5 - 1.7]，p < 0.001），1年死亡率也更高（24.9%对16.1%，调整后相对风险1.6[95%置信区间：1.3 - 1.8]，p < 0.001）。功能和精神状态在手术前后出现下降拐点，且在次年未恢复到基线轨迹。此外，一部分疗养院居民的大便失禁情况恶化。
本研究表明所有老年患者30天并发症和1年死亡率较高（疗养院居民情况更差）。最终，初级保健提供者和外科医生应仔细权衡痔疮手术对居住在疗养院的老年患者的潜在危害。
