Mortality and Functional Outcomes After Minor Urological Surgery in Nursing Home Residents: A National Study
- Autores: Anne M. Suskind, Shoujun Zhao, Louise C. Walter, W. John Boscardin, Emily Finlayson
- Localización: Journal of the American Geriatrics Society, ISSN 0002-8614, Vol. 66, Nº. 5, 2018, págs. 909-915
- Idioma: inglés
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Resumen
Objectives To determine outcomes of minor urological surgery in frail older adults.
Design Retrospective cohort study.
Setting U.S. nursing homes (NHs).
Participants NH residents aged 65 and older undergoing minor inpatient urological surgery (cystoscopy, bladder biopsy, transurethral resection of bladder tumor, prostate biopsy, transurethral resection of prostate, removal of ureteral obstruction, suprapubic tube placement) in the United States between 2004 and 2012 (N=34,605).
Measurements One‐year mortality and changes in functional status before and after surgery using the Minimum Data Set Activity of Daily Living (MDS‐ADL) summary scale.
Results Overall 1‐year mortality was 50%, and on average, residents had a 1.9‐point worsening in their MDS‐ADL score at 1 year, whereas the most highly functional residents (baseline quartile of MDS‐ADL scores (0–12)) had a 4.7‐point worsening in their MDS‐ADL scores at 1 year. Functional decline in residents 1 year after surgery was associated with decline in function in the 6 months before surgery (adjusted hazard ratio (aH)=2.39, 95% confidence interval (CI)=2.29–2.49), emergency procedures (aHR=1.37, 95% CI=1.31–1.43), older age (≥85 vs 65–74, aHR=1.17, 95% CI=1.11–1.23), and baseline cognitive impairment (aHR=1.15, 95% CI=1.11–1.20).
Conclusion Despite the low complexity of minor urological procedures, NH residents experience high mortality and many demonstrate sustained functional decline up to 1‐year postoperatively.
