Functional Outcomes After Major Surgery in Nursing Home Residents

描述(申请人提供)：养老院老年居民经常面临大手术的决定。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，包括老年学家和外科医生，都需要关于预期结果的信息，以便知道何时转介患者进行手术，以及何时适合为虚弱的老年患者进行手术。疗养院的患者及其家人也需要信息，以便在知情的情况下决定是否继续手术。然而，考虑到关于高龄和虚弱如何影响手术风险的有限信息，明智的决策是具有挑战性的。此外，大手术对养老院居民认知和功能健康状况的影响还没有被很好地了解。为了弥补这些差距，我们的项目有三个具体目标： 目的一、描述最虚弱的老年人接受大手术后的结果。将全国医疗保险申领联系起来 从国家疗养院最低数据集(MDS，1999-2005)的纵向数据(1999-2004)到纵向数据，我们将检查接受重大择期手术和紧急手术的疗养院患者的临床结果。结果将包括死亡率、并发症、ICU住院时间、住院时间和再次住院。 目的II.评估手术对患者认知和功能状态的影响。利用相同的数据来源，我们将检验大手术对养老院老年居民认知能力和功能状态的影响。 目的III.更好地预测疗养院患者的手术结果。运用多因素分析，我们将评估患者的年龄、医疗合并症、术前功能状态和认知功能对养老院患者术后结果的影响。我们还将评估这些患者特征之间的相互作用。通过这三个目标，我们将为疗养院居民和他们的照顾者提供急需的关于大手术后的功能和临床结果的信息。

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.