Preexisting Dementia Is Associated with Increased Risks of Mortality and Morbidity Following Major Surgery: A Nationwide Propensity Score Matching Study.
Preexisting Dementia Is Associated with Increased Risks of Mortality and Morbidity Following Major Surgery: A Nationwide Propensity Score Matching Study.
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DOI：
10.3390/ijerph17228431
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发表时间：
2020-11-14
影响因子：
--
通讯作者：
Tai YH
中科院分区：
文献类型：
--
作者：
Wu YM;Kuo HC;Li CC;Wu HL;Chen JT;Cherng YG;Chen TJ;Dai YX;Liu HY;Tai YH
痴呆症患者易患多种生理异常。目前尚不确定痴呆是否与围手术期死亡率和发病率较高有关。我们使用台湾全民健康保险的报销数据，并进行倾向评分匹配分析，以评估2004年至2013年期间接受大手术的痴呆或非痴呆患者的死亡率和主要并发症风险。我们应用多变量logistic回归计算了关注结果的调整优势比（aOR）和95%置信区间（CI）。在匹配人口统计学和临床协变量后，选择了7863对匹配对进行分析。痴呆症与30天住院死亡率的风险显著相关（aOR：1.71，95% CI：1.09-2.70），肺炎（aOR：1.48，95%CI：1.16-1.88）、尿路感染（aOR：1.59，95%CI：1.30-1.96）和脓毒症（OR：1.77，95%CI：1.34-2.34）。痴呆患者的死亡风险降低，但随着时间的推移持续存在，术后180天（aOR：1.49，95% CI：1.23-1.81）和365天（aOR：1.52，95% CI：1.30-1.78）。此外，与非痴呆对照组相比，痴呆患者更可能接受输血（aOR：1.32，95% CI：1.11-1.58）和需要重症监护（aOR：1.40，95% CI：1.12-1.76）。老年痴呆和阿尔茨海默病与围手术期死亡率和并发症的发生率较高独立相关，但血管性痴呆不受影响。我们发现，先前存在的痴呆症与大手术后的死亡率和发病率相关。
Patients with dementia are predisposed to multiple physiological abnormalities. It is uncertain if dementia associates with higher rates of perioperative mortality and morbidity. We used reimbursement claims data of Taiwan’s National Health Insurance and conducted propensity score matching analyses to evaluate the risk of mortality and major complications in patients with or without dementia undergoing major surgery between 2004 and 2013. We applied multivariable logistic regressions to calculate adjusted odds ratios (aORs) with 95% confidence intervals (CIs) for the outcome of interest. After matching to demographic and clinical covariates, 7863 matched pairs were selected for analysis. Dementia was significantly associated with greater risks of 30-day in-hospital mortality (aOR: 1.71, 95% CI: 1.09–2.70), pneumonia (aOR: 1.48, 95% CI: 1.16–1.88), urinary tract infection (aOR: 1.59, 95% CI: 1.30–1.96), and sepsis (OR: 1.77, 95% CI: 1.34–2.34) compared to non-dementia controls. The mortality risk in dementia patients was attenuated but persisted over time, 180 days (aOR: 1.49, 95% CI: 1.23–1.81) and 365 days (aOR: 1.52, 95% CI: 1.30–1.78) after surgery. Additionally, patients with dementia were more likely to receive blood transfusion (aOR: 1.32, 95% CI: 1.11–1.58) and to need intensive care (aOR: 1.40, 95% CI: 1.12–1.76) compared to non-dementia controls. Senile dementia and Alzheimer’s disease were independently associated with higher rates of perioperative mortality and complications, but vascular dementia was not affected. We found that preexisting dementia was associated with mortality and morbidity after major surgery.
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DOI：
10.1016/j.athoracsur.2015.12.074
发表时间：
2016-05
期刊：
The Annals of thoracic surgery
影响因子：
--
作者：
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发表时间：
2018
期刊：
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影响因子：
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