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

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Title: Patients living with dementia have worse outcomes when undergoing high‐risk procedures.
Authors: Shah, Samir K., Adler, Rachel R., Xiang, Lingwei, Clark, Clancy J., Cooper, Zara, Finlayson, Emily, Kim, Dae Hyun, Lin, Kueiyu Joshua, Lipsitz, Stuart R., Weissman, Joel S.
Source: Journal of the American Geriatrics Society. Oct2022, Vol. 70 Issue 10, p2838-2846. 9p.
Subjects: Alzheimer's disease, Confidence intervals, Operative surgery, Mortality, Multivariate analysis, Surgical complications, Patient-centered care, Retrospective studies, Tertiary care, Comparative studies, Dementia, Odds ratio, Discharge planning, Longitudinal method, Medicare
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. [ABSTRACT FROM AUTHOR]
Copyright of Journal of the American Geriatrics Society is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
Database: Psychology and Behavioral Sciences Collection
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  Data: Patients living with dementia have worse outcomes when undergoing high‐risk procedures.
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  Data: <searchLink fieldCode="AR" term="%22Shah%2C+Samir+K%2E%22">Shah, Samir K.</searchLink><br /><searchLink fieldCode="AR" term="%22Adler%2C+Rachel+R%2E%22">Adler, Rachel R.</searchLink><br /><searchLink fieldCode="AR" term="%22Xiang%2C+Lingwei%22">Xiang, Lingwei</searchLink><br /><searchLink fieldCode="AR" term="%22Clark%2C+Clancy+J%2E%22">Clark, Clancy J.</searchLink><br /><searchLink fieldCode="AR" term="%22Cooper%2C+Zara%22">Cooper, Zara</searchLink><br /><searchLink fieldCode="AR" term="%22Finlayson%2C+Emily%22">Finlayson, Emily</searchLink><br /><searchLink fieldCode="AR" term="%22Kim%2C+Dae+Hyun%22">Kim, Dae Hyun</searchLink><br /><searchLink fieldCode="AR" term="%22Lin%2C+Kueiyu+Joshua%22">Lin, Kueiyu Joshua</searchLink><br /><searchLink fieldCode="AR" term="%22Lipsitz%2C+Stuart+R%2E%22">Lipsitz, Stuart R.</searchLink><br /><searchLink fieldCode="AR" term="%22Weissman%2C+Joel+S%2E%22">Weissman, Joel S.</searchLink>
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  Data: <searchLink fieldCode="JN" term="%22Journal+of+the+American+Geriatrics+Society%22">Journal of the American Geriatrics Society</searchLink>. Oct2022, Vol. 70 Issue 10, p2838-2846. 9p.
– Name: Subject
  Label: Subjects
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  Data: <searchLink fieldCode="DE" term="%22Alzheimer's+disease%22">Alzheimer's disease</searchLink><br /><searchLink fieldCode="DE" term="%22Confidence+intervals%22">Confidence intervals</searchLink><br /><searchLink fieldCode="DE" term="%22Operative+surgery%22">Operative surgery</searchLink><br /><searchLink fieldCode="DE" term="%22Mortality%22">Mortality</searchLink><br /><searchLink fieldCode="DE" term="%22Multivariate+analysis%22">Multivariate analysis</searchLink><br /><searchLink fieldCode="DE" term="%22Surgical+complications%22">Surgical complications</searchLink><br /><searchLink fieldCode="DE" term="%22Patient-centered+care%22">Patient-centered care</searchLink><br /><searchLink fieldCode="DE" term="%22Retrospective+studies%22">Retrospective studies</searchLink><br /><searchLink fieldCode="DE" term="%22Tertiary+care%22">Tertiary care</searchLink><br /><searchLink fieldCode="DE" term="%22Comparative+studies%22">Comparative studies</searchLink><br /><searchLink fieldCode="DE" term="%22Dementia%22">Dementia</searchLink><br /><searchLink fieldCode="DE" term="%22Odds+ratio%22">Odds ratio</searchLink><br /><searchLink fieldCode="DE" term="%22Discharge+planning%22">Discharge planning</searchLink><br /><searchLink fieldCode="DE" term="%22Longitudinal+method%22">Longitudinal method</searchLink><br /><searchLink fieldCode="DE" term="%22Medicare%22">Medicare</searchLink>
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: 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. [ABSTRACT FROM AUTHOR]
– Name: AbstractSuppliedCopyright
  Label:
  Group: Ab
  Data: <i>Copyright of Journal of the American Geriatrics Society is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
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RecordInfo BibRecord:
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    Identifiers:
      – Type: doi
        Value: 10.1111/jgs.17893
    Languages:
      – Code: eng
        Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 9
        StartPage: 2838
    Subjects:
      – SubjectFull: Alzheimer's disease
        Type: general
      – SubjectFull: Confidence intervals
        Type: general
      – SubjectFull: Operative surgery
        Type: general
      – SubjectFull: Mortality
        Type: general
      – SubjectFull: Multivariate analysis
        Type: general
      – SubjectFull: Surgical complications
        Type: general
      – SubjectFull: Patient-centered care
        Type: general
      – SubjectFull: Retrospective studies
        Type: general
      – SubjectFull: Tertiary care
        Type: general
      – SubjectFull: Comparative studies
        Type: general
      – SubjectFull: Dementia
        Type: general
      – SubjectFull: Odds ratio
        Type: general
      – SubjectFull: Discharge planning
        Type: general
      – SubjectFull: Longitudinal method
        Type: general
      – SubjectFull: Medicare
        Type: general
    Titles:
      – TitleFull: Patients living with dementia have worse outcomes when undergoing high‐risk procedures.
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            – D: 01
              M: 10
              Text: Oct2022
              Type: published
              Y: 2022
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