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. 2022 Oct;70(10):2838-2846.
doi: 10.1111/jgs.17893. Epub 2022 May 30.

Patients living with dementia have worse outcomes when undergoing high-risk procedures

Samir K Shah  1 , Rachel R Adler  2 , Lingwei Xiang  2 , Clancy J Clark  3 , Zara Cooper  2 , Emily Finlayson  4 , Dae Hyun Kim  5 , Kueiyu Joshua Lin  6 , Stuart R Lipsitz  2 , Joel S Weissman  2
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Patients living with dementia have worse outcomes when undergoing high-risk procedures

Samir K Shah et al. J Am Geriatr Soc. 2022 Oct.

Abstract

Background: Patients with Alzheimer's Disease and Related Dementias (ADRD) undergoing inpatient procedures represent a population at elevated risk for adverse outcomes including postoperative complications, mortality, and discharge to a higher level of care. Outcomes may be particularly poor in patients with ADRD undergoing high-risk procedures. We sought to determine traditional (e.g., 30-day mortality) and patient-centered (e.g., discharge disposition) outcomes in patients with ADRD undergoing high-risk inpatient procedures.

Methods: This retrospective cohort study analyzed electronic health records linked to fee-for-service Medicare claims data at a tertiary care academic health system. All patients from a large multi-hospital health system undergoing high-risk inpatient procedures from October 1, 2015 to September 30, 2017 with continuous Medicare Parts A and B enrollment in the 12 months prior to and 90 days following the procedure were included.

Results: This study included 6779 patients. 536 (7.9%) had ADRD. A multivariable analysis of outcomes demonstrated higher risks for postoperative complications (OR 1.49, 95% CI 1.23-1.81) and 90-day mortality (OR 1.44 [95% CI 1.09-1.91]) in patients with ADRD compared to those without. Patients with ADRD were more likely to be discharged to a higher level of care (OR 1.70, 95% CI 1.32-2.18) and only 37.3% of patients admitted from home were discharged to home.

Conclusions: Compared to those without ADRD, patients living with ADRD undergoing high-risk procedures have poor traditional and patient-centered outcomes including increased risks for 90-day mortality, postoperative complications, longer hospital lengths of stay, and discharge to a higher level of care. These data may be used by patients, their surrogates, and their physicians to help align surgical decision-making with health care goals.

Keywords: dementia; electronic health records; surgery; surgical outcomes.

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Conflict of interest statement

Conflict of Interest. The authors have no conflicts of interest.

Figures

Figure 1.
Figure 1.. Summary of outcomes after high-risk inpatient procedures in patients living with ADRD.
Attribution: This figure has been made using resources from Flaticon.com
See this image and copyright information in PMC

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