Functional Outcomes After Major Surgery in Nursing Home Residents

描述（由申请人提供）：养老院的老人经常面临大手术的决定。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是必要的。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，以及何时适合对虚弱的老年患者进行手术。疗养院的病人和他们的家人也需要信息来做出是否进行手术的明智决定。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尚不清楚。为了解决这些差距，我们的项目有三个具体目标：

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.