Postoperative Adverse Outcomes in Intellectually Disabled Surgical Patients: A Nationwide Population-Based Study

Abstract

BackgroundIntellectually disabled patients have various comorbidities, but their risks of adverse surgical outcomes have not been examined. This study assesses pre-existing comorbidities, adjusted risks of postoperative major morbidities and mortality in intellectually disabled surgical patients.MethodsA nationwide population-based study was conducted in patients who underwent inpatient major surgery in Taiwan between 2004 and 2007. Four controls for each patient were randomly selected from the National Health Insurance Research Database. Preoperative major comorbidities, postoperative major complications and 30-day in-hospital mortality were compared between patients with and without intellectual disability. Use of medical services also was analyzed. Adjusted odds ratios using multivariate logistic regression analyses with 95% confidence intervals were applied to verify intellectual disability's impact.ResultsControls were compared with 3983 surgical patients with intellectual disability. Risks for postoperative major complications were increased in patients with intellectual disability, including acute renal failure (odds ratio 3.81, 95% confidence interval 2.28 to 6.37), pneumonia (odds ratio 2.01, 1.61 to 2.49), postoperative bleeding (odds ratio 1.35, 1.09 to 1.68) and septicemia (odds ratio 2.43, 1.85 to 3.21) without significant differences in overall mortality. Disability severity was positively correlated with postoperative septicemia risk. Medical service use was also significantly higher in surgical patients with intellectual disability.ConclusionIntellectual disability significantly increases the risk of overall major complications after major surgery. Our findings show a need for integrated and revised protocols for postoperative management to improve care for intellectually disabled surgical patients.

Factors Related to Complications Among Adult Patients With Intellectual Disabilities Hospitalized at an Academic Medical Center

“…The finding on risk of complications postsurgical procedures is similar to the Lin et al (2011) study, continuing to indicate surgical procedure as a risk factor for complications among patients with ID. Because multiple chronic conditions are known to be associated with poor health outcomes, the finding that the presence of multiple chronic conditions, along with admission through the emergency department, is related to complications during hospitalization is also a useful initial indicator of complication risk.…”

“…The chi-square test has the advantage that it makes no assumptions about the distribution of the population. Because a previous study indicated that surgical procedure was a risk factor for complications (Lin et al, 2011), a chi-square test was used to determine if surgical procedure was associated with complications in this study. The chi-square was set up with a two by two cross-tabulation table, with surgical procedure coded as 1 and not surgical procedure coded as zero, and complication coded as 1 and no complication coded as zero.…”

“…In a systematic review of literature, it was found that, despite 20 years of efforts, people with intellectual disabilities continue to have poor hospital outcomes and experiences (Iacono, Bigby, Unsworth, Douglas, & Fitzpatrick, 2014). When hospitalized, people with ID had higher risks of complications after inpatient major surgery than did patients without ID; overall complications odds ratio was 1.53, compared to patients without ID (Lin, Liao, Chang, Chang, & Chen, 2011). Patients with ID also had higher rates of complications (unintended adverse events; UHC [formerly known as University Healthsystem Consortium], 2013) than did patients without ID hospitalized with the same diagnoses valid at discharge for three of the five main diagnoses for patients with ID (Ailey, Johnson, Fogg, & Friese, 2014).…”

Adverse outcomes after major surgery in patients with systemic lupus erythematosus: a nationwide population-based study

“…Urbanisation was estimated from the population density (people/km 2 ), defined by dividing the 359 townships and city districts’ populations by the area (km 2 ) of each administrative unit and categorised into four quartiles: low, moderate, high and very high urbanisation. In accordance with the International Classification of Diseases, 9th revision, clinical modification (ICD-9-CM), we defined preoperative SLE (ICD-9-CM 710.0) and major coexisting medical illnesses including hypertension (ICD-9-CM 401-405), chronic obstructive pulmonary disease (ICD-9-CM 490-496), diabetes mellitus (ICD-9-CM 250), stroke (ICD-9-CM 430-438), acute myocardial infarction (ICD-9-CM 410), congestive heart failure (ICD-9-CM 428), peripheral vascular disease (ICD-9-CM 443) and acute renal failure (ICD-9-CM 584) as being recorded from medical claims for the 24-month preoperative period 13. Renal dialysis was also considered as preoperative functional status.…”

Hospitalizations of Adults With Intellectual Disability in Academic Medical Centers

“…Using MFDLINE, CINAHL, and PsychlNFO datahases, no research in the last 10 years was found on common reasons for which individuals with ID are hospitalized and, with the exception of a study on postoperative complications (Lin, Liao, Chang, Chang, & Chen, 2011), none on outcomes for this population when hospitalized for medical conditions. Information on hospitalizations of individuals with ID would he useful in guiding efforts to improve hospital care for individuals with ID.…”