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Patients With Dementia Undergoing High‐Risk Inpatient Surgery Have Poor Outcomes.

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Title: Patients With Dementia Undergoing High‐Risk Inpatient Surgery Have Poor Outcomes.
Authors: Shah, Samir K. (AUTHOR), Xiang, Lingwei (AUTHOR), Adler, Rachel R. (AUTHOR), Clark, Clancy J. (AUTHOR), Cooper, Zara (AUTHOR), Finlayson, Emily (AUTHOR), Mitchell, Susan L. (AUTHOR), Kim, Dae Hyun (AUTHOR), Lin, Kueiyu Joshua (AUTHOR), Lipsitz, Stuart R. (AUTHOR), Weissman, Joel S. (AUTHOR)
Source: Journal of the American Geriatrics Society. Nov2025, Vol. 73 Issue 11, p3434-3443. 10p.
Subjects: Risk assessment, Research funding, Alzheimer's disease, Hospital care, Medicare, Fee for service (Medical fees), Fisher exact test, Logistic regression analysis, Health insurance, Treatment effectiveness, Retrospective studies, Descriptive statistics, Mann Whitney U Test, Chi-squared test, Hospital mortality, Discharge planning, Decision making in clinical medicine, Operative surgery, Surgical complications, Longitudinal method, Odds ratio, Nursing care facilities, Medical records, Acquisition of data, Dementia, Data analysis software, Confidence intervals, Length of stay in hospitals, Dementia patients, Regression analysis, Proportional hazards models, Feeding tubes, Advance directives (Medical care), Disease risk factors, Disease complications
Geographic Terms: United States
Abstract: Background: Surgery is common among patients living with dementia, and understanding outcomes may help decision‐making. We compared patients' and utilization outcomes after high‐risk surgery among patients with and without dementia. Methods: In this retrospective national cohort study, we compared outcomes of Medicare fee‐for‐service beneficiaries 66 years or older who underwent high‐risk inpatient surgery (i.e., with an inpatient mortality of at least 1%) from January 1, 2017 to September 30, 2018. We examined 90‐ and 30‐day all‐cause mortality, major complications, discharge to a higher level of care, intensive end‐of‐life interventions, and prolonged skilled nursing facility (SNF) stay. We used generalized estimating equations regression modeling and competing risks analysis. Results: Among 19,998,187 beneficiaries, we identified 859,570 who had fee‐for‐service coverage and were 66 years or older at the time of a high‐risk surgery. Of these, 124,822 (14.5%) had a diagnosis of dementia. Female sex accounted for 81,252 (65.1%) of the dementia cohort. Four of five of the most common procedures were related to femur fracture and cardiac surgery in the dementia and non‐dementia cohorts. Ninety‐day mortality was worse among patients with dementia: 22.8% versus 9.3% (adjusted odds ratio [aOR] 1.82, 95% confidence interval [CI] 1.78–1.85). Patients with dementia were also more likely to have major complications (51.6% vs. 38.5%, aOR 1.19, 95% CI 1.17–1.20), be discharged to a higher level of care (75.1% vs. 41.3%, aOR 1.49, 95% CI 1.44–1.53), and have a prolonged SNF stay (3.7% vs. 1.4%, aOR 1.80, 95% CI 1.69–1.91). Although patients with ADRD were overall less likely to receive intensive interventions during the index admission and at 90 days, they were more likely to receive feeding tubes (aOR 1.22, 95% CI 1.17–1.28). Conclusion: Persons living with dementia experience a broad range of worse outcomes after high‐risk surgery compared to those without dementia. These data may be used for decision‐making. [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 With Dementia Undergoing High‐Risk Inpatient Surgery Have Poor Outcomes.
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  Data: <searchLink fieldCode="AR" term="%22Shah%2C+Samir+K%2E%22">Shah, Samir K.</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Xiang%2C+Lingwei%22">Xiang, Lingwei</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Adler%2C+Rachel+R%2E%22">Adler, Rachel R.</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Clark%2C+Clancy+J%2E%22">Clark, Clancy J.</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Cooper%2C+Zara%22">Cooper, Zara</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Finlayson%2C+Emily%22">Finlayson, Emily</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Mitchell%2C+Susan+L%2E%22">Mitchell, Susan L.</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Kim%2C+Dae+Hyun%22">Kim, Dae Hyun</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Lin%2C+Kueiyu+Joshua%22">Lin, Kueiyu Joshua</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Lipsitz%2C+Stuart+R%2E%22">Lipsitz, Stuart R.</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Weissman%2C+Joel+S%2E%22">Weissman, Joel S.</searchLink> (AUTHOR)
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  Data: <searchLink fieldCode="JN" term="%22Journal+of+the+American+Geriatrics+Society%22">Journal of the American Geriatrics Society</searchLink>. Nov2025, Vol. 73 Issue 11, p3434-3443. 10p.
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  Data: <searchLink fieldCode="DE" term="%22Risk+assessment%22">Risk assessment</searchLink><br /><searchLink fieldCode="DE" term="%22Research+funding%22">Research funding</searchLink><br /><searchLink fieldCode="DE" term="%22Alzheimer's+disease%22">Alzheimer's disease</searchLink><br /><searchLink fieldCode="DE" term="%22Hospital+care%22">Hospital care</searchLink><br /><searchLink fieldCode="DE" term="%22Medicare%22">Medicare</searchLink><br /><searchLink fieldCode="DE" term="%22Fee+for+service+%28Medical+fees%29%22">Fee for service (Medical fees)</searchLink><br /><searchLink fieldCode="DE" term="%22Fisher+exact+test%22">Fisher exact test</searchLink><br /><searchLink fieldCode="DE" term="%22Logistic+regression+analysis%22">Logistic regression analysis</searchLink><br /><searchLink fieldCode="DE" term="%22Health+insurance%22">Health insurance</searchLink><br /><searchLink fieldCode="DE" term="%22Treatment+effectiveness%22">Treatment effectiveness</searchLink><br /><searchLink fieldCode="DE" term="%22Retrospective+studies%22">Retrospective studies</searchLink><br /><searchLink fieldCode="DE" term="%22Descriptive+statistics%22">Descriptive statistics</searchLink><br /><searchLink fieldCode="DE" term="%22Mann+Whitney+U+Test%22">Mann Whitney U Test</searchLink><br /><searchLink fieldCode="DE" term="%22Chi-squared+test%22">Chi-squared test</searchLink><br /><searchLink fieldCode="DE" term="%22Hospital+mortality%22">Hospital mortality</searchLink><br /><searchLink fieldCode="DE" term="%22Discharge+planning%22">Discharge planning</searchLink><br /><searchLink fieldCode="DE" term="%22Decision+making+in+clinical+medicine%22">Decision making in clinical medicine</searchLink><br /><searchLink fieldCode="DE" term="%22Operative+surgery%22">Operative surgery</searchLink><br /><searchLink fieldCode="DE" term="%22Surgical+complications%22">Surgical complications</searchLink><br /><searchLink fieldCode="DE" term="%22Longitudinal+method%22">Longitudinal method</searchLink><br /><searchLink fieldCode="DE" term="%22Odds+ratio%22">Odds ratio</searchLink><br /><searchLink fieldCode="DE" term="%22Nursing+care+facilities%22">Nursing care facilities</searchLink><br /><searchLink fieldCode="DE" term="%22Medical+records%22">Medical records</searchLink><br /><searchLink fieldCode="DE" term="%22Acquisition+of+data%22">Acquisition of data</searchLink><br /><searchLink fieldCode="DE" term="%22Dementia%22">Dementia</searchLink><br /><searchLink fieldCode="DE" term="%22Data+analysis+software%22">Data analysis software</searchLink><br /><searchLink fieldCode="DE" term="%22Confidence+intervals%22">Confidence intervals</searchLink><br /><searchLink fieldCode="DE" term="%22Length+of+stay+in+hospitals%22">Length of stay in hospitals</searchLink><br /><searchLink fieldCode="DE" term="%22Dementia+patients%22">Dementia patients</searchLink><br /><searchLink fieldCode="DE" term="%22Regression+analysis%22">Regression analysis</searchLink><br /><searchLink fieldCode="DE" term="%22Proportional+hazards+models%22">Proportional hazards models</searchLink><br /><searchLink fieldCode="DE" term="%22Feeding+tubes%22">Feeding tubes</searchLink><br /><searchLink fieldCode="DE" term="%22Advance+directives+%28Medical+care%29%22">Advance directives (Medical care)</searchLink><br /><searchLink fieldCode="DE" term="%22Disease+risk+factors%22">Disease risk factors</searchLink><br /><searchLink fieldCode="DE" term="%22Disease+complications%22">Disease complications</searchLink>
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  Data: <searchLink fieldCode="DE" term="%22United+States%22">United States</searchLink>
– Name: Abstract
  Label: Abstract
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  Data: Background: Surgery is common among patients living with dementia, and understanding outcomes may help decision‐making. We compared patients' and utilization outcomes after high‐risk surgery among patients with and without dementia. Methods: In this retrospective national cohort study, we compared outcomes of Medicare fee‐for‐service beneficiaries 66 years or older who underwent high‐risk inpatient surgery (i.e., with an inpatient mortality of at least 1%) from January 1, 2017 to September 30, 2018. We examined 90‐ and 30‐day all‐cause mortality, major complications, discharge to a higher level of care, intensive end‐of‐life interventions, and prolonged skilled nursing facility (SNF) stay. We used generalized estimating equations regression modeling and competing risks analysis. Results: Among 19,998,187 beneficiaries, we identified 859,570 who had fee‐for‐service coverage and were 66 years or older at the time of a high‐risk surgery. Of these, 124,822 (14.5%) had a diagnosis of dementia. Female sex accounted for 81,252 (65.1%) of the dementia cohort. Four of five of the most common procedures were related to femur fracture and cardiac surgery in the dementia and non‐dementia cohorts. Ninety‐day mortality was worse among patients with dementia: 22.8% versus 9.3% (adjusted odds ratio [aOR] 1.82, 95% confidence interval [CI] 1.78–1.85). Patients with dementia were also more likely to have major complications (51.6% vs. 38.5%, aOR 1.19, 95% CI 1.17–1.20), be discharged to a higher level of care (75.1% vs. 41.3%, aOR 1.49, 95% CI 1.44–1.53), and have a prolonged SNF stay (3.7% vs. 1.4%, aOR 1.80, 95% CI 1.69–1.91). Although patients with ADRD were overall less likely to receive intensive interventions during the index admission and at 90 days, they were more likely to receive feeding tubes (aOR 1.22, 95% CI 1.17–1.28). Conclusion: Persons living with dementia experience a broad range of worse outcomes after high‐risk surgery compared to those without dementia. These data may be used for decision‐making. [ABSTRACT FROM AUTHOR]
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  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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        Value: 10.1111/jgs.70091
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        Text: English
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        StartPage: 3434
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      – SubjectFull: Risk assessment
        Type: general
      – SubjectFull: Research funding
        Type: general
      – SubjectFull: Alzheimer's disease
        Type: general
      – SubjectFull: Hospital care
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      – SubjectFull: Decision making in clinical medicine
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      – SubjectFull: Operative surgery
        Type: general
      – SubjectFull: Surgical complications
        Type: general
      – SubjectFull: Longitudinal method
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      – SubjectFull: Odds ratio
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      – SubjectFull: Nursing care facilities
        Type: general
      – SubjectFull: Medical records
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      – SubjectFull: Acquisition of data
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      – SubjectFull: Dementia
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      – SubjectFull: Data analysis software
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      – SubjectFull: Confidence intervals
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      – SubjectFull: Length of stay in hospitals
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      – SubjectFull: Dementia patients
        Type: general
      – SubjectFull: Regression analysis
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      – SubjectFull: Proportional hazards models
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      – SubjectFull: Feeding tubes
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      – SubjectFull: Disease risk factors
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      – SubjectFull: Disease complications
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      – SubjectFull: United States
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      – TitleFull: Patients With Dementia Undergoing High‐Risk Inpatient Surgery Have Poor Outcomes.
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              Text: Nov2025
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