Functional Outcomes After Major Surgery in Nursing Home Residents

描述（由申请人提供）：老年疗养院居民经常面临重大手术的决定。关于手术死亡率和出院后治疗强度的真实信息对手术决策至关重要。治疗医生（老年病学家和外科医生）需要有关预期结果的信息，以便知道何时将患者转诊进行手术以及何时适合对体弱的老年患者进行手术。疗养院的病人及其家属也需要信息来做出是否进行手术的明智决定。然而，鉴于有关高龄和虚弱如何影响手术风险的信息有限，知情决策具有挑战性。此外，大手术对养老院居民的认知和功能健康状况的影响还没有得到很好的理解。为了弥补这些差距，我们的项目有三个具体目标： 艾姆岛描述最虚弱老年人大手术后的结局。链接国家医疗保险索赔 数据（1999-2004）的纵向数据从国家最低数据集护理之家（MDS，1999- 2005），我们将检查临床结果的护理之家患者进行重大择期和紧急手术。结局将包括死亡率、并发症、ICU住院时间、住院时间和再入院。 Aim II.评估手术对患者认知和功能状态的影响。使用相同的数据来源，我们将研究大手术对老年疗养院居民认知能力和功能状态的影响。 Aim III.更好地预测护理之家患者的手术结果。使用多变量分析，我们将评估患者的年龄、内科合并症、术前功能状态和认知功能如何影响护理之家患者术后的结局。我们还将评估这些患者特征的相互作用。通过这三个目标，我们将提供养老院居民和他们的照顾者与大手术后的功能和临床结果急需的信息。

DESCRIPTION (provided by applicant): Elderly nursing home residents are frequently faced with decisions about major surgery. Realistic information about operative mortality and post-discharge treatment intensity is imperative to surgical decision making. Treating physicians, both gerontologists and surgeons, need information about expected outcomes in order to know when to refer a patient for surgery and when it is appropriate to operate on a frail elderly patient. Nursing home patients and their families also need information to make informed decisions about whether to proceed with surgery. However, informed decision-making is challenging given the limited information about how advanced age and frailty affect the risks of surgery. Moreover, the impact of major surgery on the cognitive and functional health status of nursing home residents is not well understood. To address these gaps, our project has three specific aims: Aim I. To describe outcomes after major surgery in the frailest elderly. Linking national Medicare claims data (1999-2004) to longitudinal data from the national Minimum Data Set for Nursing Homes (MDS, 1999- 2005), we will examine clinical outcomes in nursing home patients undergoing major elective and emergent surgery. Outcomes will include mortality, complications, duration of ICU stay, hospital length of stay, and hospital readmission. Aim II. To assess the effects of surgery on patients' cognitive and functional status. Using the same data sources, we will examine the effects of major surgery on cognitive ability and functional status among elderly nursing home residents. Aim III. To better predict surgical outcomes in nursing home patients. Using multivariate analysis, we will evaluate how patients' age, medical comorbidities, preoperative functional status and cognitive function influence outcomes after surgery in nursing home patients. We will also assess the interaction of these patient characteristics. Through these three aims, we will provide nursing home residents and their caregivers with much needed information about functional and clinical outcomes after major surgery.