Immediate and Long-term Outcomes of Common Urologic Procedures in Nursing Home Residents

 描述（由申请人提供）：我们对虚弱的疗养院居民常见泌尿外科手术相关结局的理解存在根本性差距。在这个独特的人群中进行手术的决定，无论是“小手术”还是“常规手术”，都是复杂的，应该通过平衡每个人的风险和受益以及改善生活质量的最终目标来仔细考虑。然而，常见泌尿外科手术的风险和益处（例如，膀胱镜检查、膀胱活组织检查、经尿道膀胱肿瘤切除术、经尿道前列腺切除术和切开术、前列腺活组织检查和压力性尿失禁手术）。长期目标是扩大我们对预期寿命有限的患者人群的生活质量的理解，并指导外科和泌尿外科护理实现这一目标。本申请的目的是 了解与护理之家居民中常见泌尿外科手术相关的即时和长期结局，这些结局超出了手术特定并发症和死亡率，以测量功能和认知状态，这对该人群非常重要。中心假设是，有大量的和显着的直接和长期并发症造成的共同泌尿外科手术中的护理之家人口，从高利率的程序特异性并发症（例如，住院时间延长、再次住院、重复泌尿外科手术、输血和新诊断的尿路感染和血尿）和持续功能和认知下降的死亡率，在决定未来的养老院居民接受这些程序时，请仔细考虑。该假设将通过利用养老院居民评估和医疗保险数据的最小数据集（MDS）进行测试，以实现两个特定目标：1）确定常见泌尿外科手术后的即刻（30天）结局（例如膀胱镜检查、膀胱活组织检查、膀胱肿瘤的经尿道切除术、前列腺的经尿道切除术和切开术、前列腺活组织检查，和压力性尿失禁的手术），并确定与不良结果相关的因素;和2）确定长期（1年）功能和认知结果后，常见的泌尿外科手术的护理之家居民，并确定与结果相关的因素。该项目具有创新性，因为它是第一个在疗养院人群中观察任何泌尿外科手术的项目，它超越了通常测量的手术结果，以评估泌尿外科手术后的长期功能和认知结果，这些手术对居民非常重要，并影响他们的生活质量，重要的是，拟议的项目提出了对这一预期寿命有限的脆弱人口进行诊断和酌情程序是否适当的问题。拟议的研究是重要的，因为它将大大提高我们的风险和利益的理解与这些程序在这一患者群体，并将改善知情决策之间的养老院提供者，居民，及其家属，这是至关重要的以病人为中心的外科护理。

 DESCRIPTION (provided by applicant): There is a fundamental gap in our understanding of outcomes related to common urologic procedures in frail nursing home residents. The decision to perform surgery in this unique population, however "minor" or "routine", is complex and should be considered carefully by balancing the risks and benefits in each individual with the ultimate goal of improving quality of life. However, the risks and benefits of common urologic procedures (e.g., cystoscopy, bladder biopsy, transurethral resection of bladder tumor, transurethral resection and incision of the prostate, prostate biopsy, and operations for stress urinary incontinence) in nursing home residents are unknown. The long-term goal is to broaden our understanding quality of life in this patient population with limited life expectancy and to direct surgical and urologic care towards this aim. The objective of this particular application is to gain an understanding of the immediate and long-term outcomes related to common urologic procedures in nursing home residents that go beyond procedure-specific complications and mortality to measure functional and cognitive status, which matter greatly to this population. The central hypothesis is that there are substantial and significant immediate and long-term complications resulting from common urologic procedures among the nursing home population, spanning from high rates of procedure-specific complications (e.g. longer hospital stays, hospital readmissions, repeat urologic procedures, blood transfusions and new diagnoses of urinary tract infection and hematuria) and mortality to lasting functional and cognitive declines, warranting careful consideration when making the decision to undergo these procedures in future nursing home residents. This hypothesis will be tested by leveraging the Minimum Data Set (MDS) for Nursing home Resident Assessment and Medicare data to pursue two specific aims: 1) Determine the immediate (30-day) outcomes following common urologic procedures (e.g. cystoscopy, bladder biopsy, transurethral resection of bladder tumor, transurethral resection and incision of the prostate, prostate biopsy, and operations for stress urinary incontinence) among nursing home residents and determine factors associated with adverse outcomes; and 2) Determine long-term (1-year) functional and cognitive outcomes following common urologic procedures among nursing home residents and determine factors associated with outcomes. This project is innovative because it is the first to look at any urologic procedures in the nursing home population, it goes beyond commonly measured surgical outcomes to evaluate long-term functional and cognitive outcomes after urologic procedures that matter dearly to residents and impact their quality of life, and importantly, the proposed project raises questions about the appropriateness of performing diagnostic and discretionary procedures in this frail population with limited life expectancy. The proposed research is significant because it will greatly enhance our understanding of the risks and benefits associated with these procedures in this patient population and will improve informed decision making among nursing home providers, residents, and their families, which is critical to patient-centered surgical care.