Anne M Suskind1, Shoujun Zhao1, Louise C Walter2,3, W John Boscardin4, Emily Finlayson5. 1. Department of Urology, University of California, San Francisco, San Francisco, California. 2. Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, California. 3. Division of Geriatrics, Veterans Affairs Medical Center, San Francisco, California. 4. Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California. 5. Department of Surgery, University of California, San Francisco, San Francisco, California.
Abstract
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.
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.
Authors: Pieter T M van Dijk; David R Mehr; Marcel E Ooms; Richard Madsen; Greg Petroski; Dinnus H Frijters; Anne Margriet Pot; Miel W Ribbe Journal: J Am Geriatr Soc Date: 2005-04 Impact factor: 5.562
Authors: Emily Finlayson; Shoujun Zhao; W John Boscardin; Brant E Fries; C Seth Landefeld; R Adams Dudley Journal: J Am Geriatr Soc Date: 2012-03-16 Impact factor: 5.562