Surgical outcomes and healthcare expenditures among patients with dementia undergoing major surgery

Abstract

BackgroundWe sought to define surgical outcomes among elderly patients with Alzheimer's disease and related dementias (ADRD) following major thoracic and gastrointestinal surgery.MethodsA retrospective cohort study was used to identify patients who underwent coronary artery bypass grafting (CABG), abdominal aortic aneurysm (AAA) repair, pneumonectomy, pancreatectomy, and colectomy. Individuals were identified from the Medicare Standard Analytic Files and multivariable regression was utilized to assess the association of ADRD with textbook outcome (TO), expenditures, and discharge disposition.ResultsAmong 1,175,010 Medicare beneficiaries, 19,406 (1.7%) patients had a preoperative diagnosis of ADRD (CABG: n = 1,643, 8.5%; AAA repair: n = 5,926, 30.5%; pneumonectomy: n = 590, 3.0%; pancreatectomy: n = 181, 0.9%; and colectomy: n = 11,066, 57.0%). After propensity score matching, patients with ADRD were less likely to achieve a TO (ADRD: 31.2% vs. no ADRD: 40.1%) or be discharged to home (ADRD: 26.7% vs. no ADRD: 46.2%) versus patients who did not have ADRD (both p < 0.001). Median index surgery expenditures were higher among patients with ADRD (ADRD: $28,815 [IQR $14,333–$39,273] vs. no ADRD: $27,101 [IQR $13,433–$38,578]; p < 0.001) (p < 0.001). On multivariable analysis, patients with ADRD had higher odds of postoperative complications (OR 1.32, 95% CI 1.25–1.40), extended length‐of‐stay (OR 1.26, 95% CI 1.21–1.32), 90‐day readmission (OR 1.37, 95% CI 1.31–1.43), and 90‐day mortality (OR 1.76, 95% CI 1.66–1.86) (all p < 0.001).ConclusionPreoperative diagnosis of ADRD was an independent risk factor for poor postoperative outcomes, discharge to non‐home settings, as well as higher healthcare expenditures. These data should serve to inform discussions and decision‐making about surgery among the growing number of older patients with cognitive deficits.

The tip of the iceberg …

“…In this edition of World Journal of Surgery, Khalil et al explore the impact of Alzheimer's Disease and related dementias (ADRDs) on textbook outcome (TO) following selected major surgeries (CABG, AAA repair, pneumonectomy, colectomy, and pancreatectomy) whether elective, urgent, or emergent. 1 TO is a composite measure consisting of no immediate postoperative complications, no extended length of stay (<75th percentile), and no readmissions or mortality within 90 days. By exploring Medicare claims data, the authors demonstrate that ADRD patients more likely suffer postoperative complications, discharge to a skilled nursing facility, and death in the immediate postoperative period or within 3 years compared to propensity-matched counterparts.…”