Optimizing surgical decision-making for nursing home residents undergoing surgery for bladder and bowel dysfunction

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PROJECT ABSTRACT: There is a fundamental gap in our understanding of outcomes related to surgery for bladder and bowel dysfunction, which are ubiquitous conditions among nursing home residents. Despite these procedures being relatively “low risk”, they are not without risk, particularly in an already functionally and cognitively limited cohort. Currently, the only available information on such outcomes are from studies conducted in younger and healthier individuals and they lack important functional and cognitive outcomes that are meaningful to older adults. Our overarching research objective is to improve care for nursing home residents with bladder and bowel dysfunction by providing them and their healthcare providers with realistic expectations about the risks and benefits of surgical treatment for these conditions. The objective for the proposed study is to better understand the surgical and functional outcomes of these procedures in the nursing home population and to provide patients and their providers with a prognostic tool to assist in the surgical decision-making process. The central hypothesis is that there are substantial and significant immediate and long-term complications resulting from these procedures, spanning from high rates of surgical morbidity and mortality (compared to community-dwelling controls) and poor functional outcomes measured by activities of daily living, cognition and specific bowel and bladder functional outcomes. This hypothesis will be tested by leveraging Minimum Data Set (MDS) for Nursing Home Resident Assessment and Medicare claims data (inpatient and outpatient) by the following three specific aims: 1) to compare short-term (30-day mortality, surgical complications, length of stay, readmission) and long-term (1-year mortality and intensity of care) surgical outcomes between nursing home residents and age-, sex- and comorbidity-matched community-dwelling older adults undergoing elective surgery for bladder and bowel dysfunction, 2) to determine longitudinal changes in functional status, cognition, and bladder and bowel function among nursing home residents following elective surgery for bladder and bowel dysfunction, and 3) to develop and internally validate a prognostic tool for nursing home residents considering elective surgery for bladder and bowel dysfunction to predict surgical morbidity, mortality and postoperative function, cognition and bladder and bowel function. This study is innovative because it will measure and apply longitudinal functional and cognitive outcomes data to a prognostic tool for surgical procedures performed to improve function among an already functionally impaired population. The proposed research is significant because there is no information about outcomes for these common conditions in this large and vulnerable population. Development of a prognostic tool to aid in this decision-making process will serve to minimize the risks of potentially unsuccessful, unnecessary and even harmful procedures, while promoting the use of such procedures among individuals who are more likely to receive benefit.