Preoperative Frailty Status and Intensity of End-of-Life Care Among Older Adults After Emergency Surgery.
Preoperative Frailty Status and Intensity of End-of-Life Care Among Older Adults After Emergency Surgery.
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DOI：
10.1016/j.jpainsymman.2020.11.013
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发表时间：
2021-07
影响因子：
4.7
通讯作者：
Cooper Z
中科院分区：
文献类型：
--
作者：
Sokas C;Lee KC;Sturgeon D;Streid J;Lipsitz SR;Weissman JS;Kim DH;Cooper Z
Emergency general surgery (EGS) is common and highly morbid for older adults, particularly for those who are frail. However, there is little data on the quality of end-of-life care (EOLC) for this population. We sought to examine the association of frailty with intensity of EOLC for older adults with and without frailty who undergo EGS but die within one year. This retrospective cohort study included 100% Medicare fee-for-service beneficiaries, ≥66 years, who underwent one of five EGS procedures with highest mortality (partial colectomy, small bowel resection, peptic ulcer disease repair, adhesiolysis, or laparotomy) between 2008 and 2014 and died within one year. A validated claims-based frailty index (CFI) identified patients who were not frail (CFI<0.15), pre-frail (0.15≤CFI<0.25), mildly frail (0.25≤CFI<0.35), and moderately to severe frail (CFI≥0.35). Multivariable adjusted logistic or Poisson regression compared post-discharge and EOL healthcare utilization. Among 138,916 older EGS adults who died within one year, 32.2% were not frail, 31.7% were pre-frail, 29.8% had mild frailty and 6.3% had moderate-to-severe frailty. Decedents with any degree of frailty experienced high intensity EOLC (p<0.01), low rates of hospice use (p<0.01), and fewer days at home. Of those who survived the index hospitalization but died within one year, moderate-to-severely frail decedents had the highest odds of visiting an emergency department (ED) (OR=1.19, CI=1.13–1.27), rehospitalization (OR=1.23, CI=1.16–1.31), or an intensive care unit (ICU) admission (OR=1.22, CI=1.13–1.30) in the last 30 days of life compared to non-frail decedents. While all older patients undergoing EGS have poor end-of-life outcomes, frail EGS patients receive the highest intensity EOLC and represent a vulnerable population for whom targeted interventions could limit burdensome treatment.
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影响因子：
7.2
作者：
DEYO, RA;CHERKIN, DC;CIOL, MA
通讯作者：
CIOL, MA
DOI：
10.1093/gerona/glz224
发表时间：
2020-06-01
影响因子：
5.1
作者：
Kim, Dae Hyun;Patorno, Elisabetta;Glynn, Robert J.
通讯作者：
Glynn, Robert J.
DOI：
10.1093/gerona/glx229
发表时间：
2018-07-01
影响因子：
5.1
作者：
Kim, Dae Hyun;Schneeweiss, Sebastian;Avorn, Jerry
通讯作者：
Avorn, Jerry
影响因子：
8.3
作者：
Kruser, Jacqueline M.;Cox, Christopher E.;Schwarze, Margaret L.
通讯作者：
Schwarze, Margaret L.
影响因子：
16.9
作者：
Joseph, Bellal;Pandit, Viraj;Rhee, Peter
通讯作者：
Rhee, Peter