Min Jolene Wong Si, Wang Yihan, Bollens-Lund Evan, Reich Amanda J, Dhanani Hiba, Ankuda Claire K, Lipsitz Stuart, Gray Tamryn F, Kim Dae Hyun, Ritchie Christine S, Cooper Zara
Center for Surgery and Public Health, Department of Surgery, Brigham and Woman's Hospital, Boston, MA.
Department of Surgery, Brigham and Woman's Hospital, Boston, MA.
Ann Surg. 2025 May 1;281(5):806-813. doi: 10.1097/SLA.0000000000006616. Epub 2024 Dec 25.
To compare differences in pain, depression, function, and informal caregiving pre-major and post-major elective surgery among older adults with and without serious illness; and determine whether serious illness was independently associated with increasing pain, depression, assistance in activities of daily living (ADLs) and informal caregiving postsurgery.
The American College of Surgeons has endorsed the integration of palliative care (PC) into surgical care in adults with serious illness but targets for PC during surgical episodes such as pain, depression, function, and informal caregiving are understudied.
We used Health and Retirement Study-linked Medicare data (2008 to 2018) to identify older (≥66 years) adults with and without serious illness who had major elective surgery. We performed difference-in-difference analysis to measure changes in pain, depression, function, and informal caregiving presurgery and postsurgery between groups. We tested associations between serious illness and changes in pain, depression, function, and informal caregiving using multivariable regression.
Among 1896 adults who had major surgery, 1139 (60%) were seriously ill. Compared with adults without serious illness, those with serious illness had greater baseline pain (43% vs 38%), depression (22% vs 13%), assistance with ADLs (12% vs 0%,) and informal caregiving (18% vs 4%); and, greater increases in assistance with ADLs presurgery and postsurgery (difference-in-difference: 6%, 95% CI: 3.7 to 8.3). Serious illness was independently associated with increasing pain [odds ratio (OR): 1.6, 95% CI: 1.1 to 2.2], depression (OR: 1.5, 95% CI: 1.1 to 2.2), assistance with ADLs (OR: 2.1, 95% CI: 1.3 to 3.4), and informal caregiving (OR: 2.1, 95% CI: 1.4 to 3.1) postsurgery.
Most older adults having elective surgery are seriously ill. Pain, depression, function, and caregiving are targets for PC to improve post-surgical outcomes.
比较患有和未患有严重疾病的老年人在择期大手术前后疼痛、抑郁、功能及非正式照护方面的差异；并确定严重疾病是否与术后疼痛加剧、抑郁、日常生活活动（ADL）需协助情况及非正式照护存在独立关联。
美国外科医师学会已认可将姑息治疗（PC）纳入患有严重疾病的成年人的外科护理中，但在手术期间如疼痛、抑郁、功能及非正式照护等方面的PC目标研究不足。
我们使用与健康和退休研究相关联的医疗保险数据（2008年至2018年）来识别进行择期大手术的患有和未患有严重疾病的老年人（≥66岁）。我们进行了双重差分分析，以测量两组术前和术后疼痛、抑郁、功能及非正式照护方面的变化。我们使用多变量回归测试严重疾病与疼痛、抑郁、功能及非正式照护变化之间的关联。
在1896名接受大手术的成年人中，1139名（60%）患有严重疾病。与未患有严重疾病的成年人相比，患有严重疾病的人基线疼痛更严重（43%对38%）、抑郁更严重（22%对13%）、ADL需协助情况更严重（12%对0%）以及非正式照护情况更严重（18%对4%）；并且，术前和术后ADL需协助情况增加幅度更大（双重差分：6%，95%置信区间：3.7至8.3）。严重疾病与术后疼痛加剧[比值比（OR）：1.6，95%置信区间：1.1至2.2]、抑郁（OR：1.5，95%置信区间：1.1至2.2）、ADL需协助情况（OR：2.1，95%置信区间：1.3至3.4）及非正式照护（OR：2.1，95%置信区间：1.4至3.1）存在独立关联。
大多数接受择期手术的老年人患有严重疾病。疼痛、抑郁、功能及照护是PC改善术后结局的目标。
