Patients living with dementia have worse outcomes when undergoing high-risk procedures.
Patients living with dementia have worse outcomes when undergoing high-risk procedures.
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DOI：
10.1111/jgs.17893
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发表时间：
2022-10
影响因子：
6.3
通讯作者：
Weissman, Joel S.
中科院分区：
文献类型：
--
作者：
Shah, Samir K.;Adler, Rachel R.;Xiang, Lingwei;Clark, Clancy J.;Cooper, Zara;Finlayson, Emily;Kim, Dae Hyun;Lin, Kueiyu Joshua;Lipsitz, Stuart R.;Weissman, Joel S.
接受住院手术的阿尔茨海默病和相关痴呆（ADRD）患者代表了不良结局风险升高的人群，包括术后并发症、死亡率和出院后接受更高水平的护理。接受高风险手术的ADRD患者的结局可能特别差。我们试图确定接受高风险住院手术的ADRD患者的传统结局（例如30天死亡率）和以患者为中心的结局（例如出院处置）。这项回顾性队列研究分析了与三级医疗学术卫生系统的医疗保险索赔数据相关的电子健康记录。纳入了2015年10月1日至2017年9月30日期间接受高风险住院手术的大型多医院卫生系统的所有患者，在手术前12个月和手术后90天内连续入组Medicare A部分和B部分。该研究包括6，779名患者。ADRD 536例（7.9%）。结局的多变量分析表明，与未发生ADRD的患者相比，发生ADRD的患者术后并发症（OR 1.49，95% CI 1.23-1.81）和90天死亡率（OR 1.44 [95% CI 1.09-1.91]）的风险更高。ADRD患者更有可能出院接受更高水平的护理（OR 1.70，95% CI 1.32-2.18），只有37.3%的在家住院患者出院回家。与无ADRD的患者相比，接受高风险手术的ADRD患者的传统和以患者为中心的结局较差，包括90天死亡率、术后并发症、住院时间更长和出院后接受更高水平的护理的风险增加。这些数据可以由患者、他们的代理人和他们的医生使用，以帮助使手术决策与医疗保健目标保持一致。
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 6,779 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.
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DOI：
10.3390/ijerph17228431
发表时间：
2020-11-14
影响因子：
--
作者：
Wu YM;Kuo HC;Li CC;Wu HL;Chen JT;Cherng YG;Chen TJ;Dai YX;Liu HY;Tai YH
通讯作者：
Tai YH
影响因子：
4.1
作者：
Kassahun WT
通讯作者：
Kassahun WT
影响因子：
4.6
作者：
Chiu, H-C;Chen, C-M;Shen, D-L
通讯作者：
Shen, D-L
影响因子：
6.3
作者：
Moura LMVR;Festa N;Price M;Volya M;Benson NM;Zafar S;Weiss M;Blacker D;Normand SL;Newhouse JP;Hsu J
通讯作者：
Hsu J
影响因子：
4.3
作者：
Shah, Samir K.;Jin, Ginger;Reich, Amanda J.;Gupta, Avni;Belkin, Michael;Weissman, Joel S.
通讯作者：
Weissman, Joel S.