Functional and cognitive outcomes after suprapubic catheter placement in nursing home residents: A national cohort study.
Functional and cognitive outcomes after suprapubic catheter placement in nursing home residents: A national cohort study.
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DOI：
10.1111/jgs.17928
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发表时间：
2022-10
影响因子：
6.3
通讯作者：
Suskind, Anne M.
中科院分区：
文献类型：
--
作者：
Chou, Wesley H.;Covinsky, Kenneth;Zhao, Shoujun;Boscardin, W. John;Finlayson, Emily;Suskind, Anne M.
长期的功能和认知结果在疗养院居民手术后知之甚少。我们的目的是评价耻骨上置管（SPT）后的结果。我们在疗养院环境中进行了一项回顾性队列研究。参与者是2014-2016年在美国接受SPT安置的长期疗养院居民。使用国际疾病分类和当前程序术语代码，在医疗保险住院患者、门诊患者和承运人文件中确定SPT位置。通过最小数据集（MDS）3.0为疗养院居民确定居民。MDS日常生活活动（MDS-ADL）和精神状态简短访谈（BIMS）评分分别用于评估功能和认知。关注的结局为术后1年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一年的功能和认知轨迹进行建模。从2014年到2016年，9，647名平均年龄为80.9岁（SD 8.1）的居民接受了SPT安置。术后1年，37.6%的住院患者死亡，而存活者中，33.7%的MDS-ADL恶化，36.2%的BIMS恶化。住院医师术后功能下降的比率更高，而术前趋势相对稳定，从未恢复到基线状态。然而，要强有力地描述SPT放置和功能下降之间的关联，需要一个没有SPT放置的倾向评分匹配队列。认知状态的下降与SPT的放置没有明显的相关性，这表明要么是弱势群体的自然病程，要么是BIMS评分的局限性。对老年人重要的结果，如功能能力和认知状态，在SPT放置后没有显示出改善。这些结果强调，在这一人群中应谨慎考虑这种“次要”手术，主要是为了缓解。
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 2014–2016 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 modelled to one year postoperatively using mixed-effect spline models. From 2014–2016, 9,647 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.
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影响因子：
7.2
作者：
DEYO, RA;CHERKIN, DC;CIOL, MA
通讯作者：
CIOL, MA
影响因子：
3.9
作者：
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影响因子：
4.9
作者：
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DOI：
10.1016/j.jamda.2012.06.004
发表时间：
2012-09-01
影响因子：
7.6
作者：
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通讯作者：
Chodosh, Joshua
影响因子：
3
作者：
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通讯作者：
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