Dementia is associated with increased mortality and poor patient-centered outcomes after vascular surgery.
Dementia is associated with increased mortality and poor patient-centered outcomes after vascular surgery.
复制标题
DOI：
10.1016/j.jvs.2019.07.087
复制
发表时间：
2020-05
影响因子：
4.3
通讯作者：
Weissman, Joel S.
中科院分区：
文献类型：
--
作者：
Shah, Samir K.;Jin, Ginger;Reich, Amanda J.;Gupta, Avni;Belkin, Michael;Weissman, Joel S.
在骨科和其他外科专业中，痴呆与并发症和死亡率增加有关，但在血管外科中受到的关注有限。因此，我们评估了接受各种开放和经皮血管外科手术的老年医疗保险患者的痴呆与手术结局的相关性。我们审查了医疗保险和医疗补助服务中心2011年1月1日至2011年12月31日期间参加医疗保险A部分按服务收费保险的受益人的索赔数据，这些受益人接受了住院血管手术。仅考虑首次入院期间的首次手术进行分析。传统结局（30天和90天死亡率、重症监护入院、并发症、住院时间）和以患者为中心的结局（出院回家、延长的专业护理机构[SNF]住院时间、在家时间）根据患者和手术特征使用多水平线性或logistic回归进行适当调整。所有分析均使用SAS（v9.4，SAS Institute Inc，卡里，NC）进行。我们的研究包括210，918名接受血管手术的患者，其中27，920名被诊断为痴呆症。整个队列的平均年龄为75.74岁，55.43%为男性。与未诊断为痴呆的患者相比，痴呆患者年龄更大，合并症的发生率更高。最常见的三种定义的干预类别（不包括其他类别）为脑血管、外周动脉和主动脉病例，共占病例的53.15%。开放性手术占56.62%。在痴呆患者中，急诊/急诊病例更常见（60.66% vs 37.93%; P <0.001）。校正后，痴呆患者30天死亡率（比值比[OR]，1.21; P < .0001）和90天死亡率（OR，1.63; P < .0001）的比值增加，SNF住院时间延长（OR，3.47; P < .0001），住院时间延长（8.29天vs 5.41天; P < .001）。他们不太可能出院回家（OR，0.31; P < .0001），出院后在家的时间比例较低（63.29% vs 86.91%; P < .001）。两组的重症监护入院和住院并发症相似。痴呆症与不良的传统结局相关，包括在这个大型国家患者样本中增加的30天和90天死亡率以及更长的住院时间。它还与更差的以患者为中心的结果相关，包括出院回家的比率大幅降低，出院后在家停留的时间减少，以及SNF的长期停留率较高。这些数据应用于咨询面临血管手术的患者，以提供目标一致的护理，特别是对痴呆患者。
Dementia has been associated with increased complications and mortality in orthopedics and other surgical specialties, but has received limited attention in vascular surgery. Therefore, we evaluated the association of dementia with surgical outcomes for elderly patients with Medicare who underwent a variety of open and percutaneous vascular surgery procedures. We reviewed claims data from the Centers for Medicare and Medicaid Services for beneficiaries enrolled in Medicare Part A fee-for-service insurance from January 1, 2011, to December 31, 2011, who underwent inpatient vascular surgery. Only the first surgery during the first admission was considered for analysis. Traditional outcomes (30- and 90-day mortality, intensive care admission, complications, length of stay) and patient-centered outcomes (discharge to home, extended skilled nursing facility [SNF] stay, time at home) were adjusted for patient and procedure characteristics using multilevel linear or logistic regression as appropriate. All analyses were performed using SAS (v9.4, SAS Institute Inc, Cary, NC). Our study included 210,918 patients undergoing vascular surgery, of whom 27,920 carried a diagnosis of dementia. The average age of the entire cohort was 75.74 years, and 55.43% were male. Patients with dementia were older and had higher rates of comorbidities compared with patients without a dementia diagnosis. The three most common defined classes of intervention excluding miscellaneous ones were cerebrovascular, peripheral arterial, and aortic cases, which jointly accounted for 53.15% of cases. Among all cases, 56.62% were open. Emergent/urgent cases were more frequent amongst those with dementia (60.66% vs 37.93%; P < .001). After adjustment, patients with dementia had increased odds of 30-day mortality (odds ratio [OR], 1.21; P < .0001) and 90-day mortality (OR, 1.63; P < .0001), extended SNF stay (OR, 3.47; P < .0001), and longer hospital length of stay (8.29 days vs 5.41 days; P < .001). They were less likely to be discharged home (OR, 0.31; P < .0001) and spent a lower fraction of time at home after discharge (63.29% vs 86.91%; P < .001). Intensive care admission and inpatient complications were similar between the two groups. Dementia is associated with poor traditional outcomes, including increased 30- and 90-day mortality and longer hospital lengths of stay in this large national patient sample. It is also associated with worse patient-centered outcomes, including substantially lower discharge rates to home, less time spent at home after discharge, and higher rates of extended stay in a SNF. These data should be used to counsel patients facing vascular surgery to provide goal-concordant care, particularly to patients with dementia.
登录
查看更多内容
影响因子：
8.3
作者：
O'Brien, Emily C.;Xian, Ying;Fonarow, Gregg C.
通讯作者：
Fonarow, Gregg C.
影响因子：
2.6
作者：
Bai J;Zhang P;Liang X;Wu Z;Wang J;Liang Y
通讯作者：
Liang Y
影响因子：
4.1
作者：
Kassahun WT
通讯作者：
Kassahun WT
影响因子：
4.3
作者：
Mehaffey, J. Hunter;Hawkins, Robert B.;Upchurch, Gilbert R., Jr.
通讯作者：
Upchurch, Gilbert R., Jr.
影响因子：
16.9
作者：
Sheetz, Kyle H.;Dimick, Justin B.;Ghaferi, Amir A.
通讯作者：
Ghaferi, Amir A.