Noriko Morioka1, Mutsuko Moriwaki2, Jun Tomio3, Kiyohide Fushimi4, Yasuko Ogata1. 1. Graduate School of Health Care Sciences, Tokyo Medical and Dental University, Tokyo, Japan. 2. Department of Tokyo Metropolitan Health Policy Advisement, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan. 3. Department of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan. 4. Health Policy and Informatics, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan.
Abstract
OBJECTIVE: To investigate whether dementia is associated with incidence of adverse events and longer hospital stays in older adults who underwent hip surgery, after adjusting for individual social and nursing care environment. DESIGN AND SETTING: Retrospective observational study using the linked data between the Japanese Diagnosis Procedure Combination database and the reports of the medical functions of hospital beds database in Japan (April 2016-March 2017). PARTICIPANTS: A total of 48,797 individuals aged 65 and older who underwent hip surgery and were discharged during the study period. METHODS: Outcomes included in-hospital death, in-hospital pneumonia, in-hospital fracture, and longer hospital stay. We performed two-level, multilevel models adjusting for individual and hospital characteristics. RESULTS: Among all participants, 20,638 individuals (42.3%) had dementia. The incidence of adverse events for those with and without dementia included in-hospital death: 2.11% and 1.11%, in-hospital pneumonia: 0.15% and 0.07%, and in-hospital fracture: 3.76% and 3.05%, respectively. The median (inter quartile range) length of hospital stay for those with and without dementia were 26 (19-39) and 25 (19-37) days, respectively. Overall, the odds ratios (95% confidence interval (CI)) of dementia for in-hospital death, in-hospital pneumonia, and in-hospital fracture were 1.12 (0.95-1.33), 0.95 (0.51-1.80), and 1.08 (0.92-1.25), respectively. Dementia was not associated with the length of hospital stay (% change) (-0.7%, 95% CI -1.6-0.3%). Admission from home, discharge to home, and lower nurse staffing were associated with prolonged hospital stays. CONCLUSIONS: Although adverse events are more likely to occur in older adults with dementia than in those without dementia after hip surgery, we found no evidence of an association between dementia and adverse events or the length of hospital stay after adjusting for individual social and nursing care environment.
OBJECTIVE: To investigate whether dementia is associated with incidence of adverse events and longer hospital stays in older adults who underwent hip surgery, after adjusting for individual social and nursing care environment. DESIGN AND SETTING: Retrospective observational study using the linked data between the Japanese Diagnosis Procedure Combination database and the reports of the medical functions of hospital beds database in Japan (April 2016-March 2017). PARTICIPANTS: A total of 48,797 individuals aged 65 and older who underwent hip surgery and were discharged during the study period. METHODS: Outcomes included in-hospital death, in-hospital pneumonia, in-hospital fracture, and longer hospital stay. We performed two-level, multilevel models adjusting for individual and hospital characteristics. RESULTS: Among all participants, 20,638 individuals (42.3%) had dementia. The incidence of adverse events for those with and without dementia included in-hospital death: 2.11% and 1.11%, in-hospital pneumonia: 0.15% and 0.07%, and in-hospital fracture: 3.76% and 3.05%, respectively. The median (inter quartile range) length of hospital stay for those with and without dementia were 26 (19-39) and 25 (19-37) days, respectively. Overall, the odds ratios (95% confidence interval (CI)) of dementia for in-hospital death, in-hospital pneumonia, and in-hospital fracture were 1.12 (0.95-1.33), 0.95 (0.51-1.80), and 1.08 (0.92-1.25), respectively. Dementia was not associated with the length of hospital stay (% change) (-0.7%, 95% CI -1.6-0.3%). Admission from home, discharge to home, and lower nurse staffing were associated with prolonged hospital stays. CONCLUSIONS: Although adverse events are more likely to occur in older adults with dementia than in those without dementia after hip surgery, we found no evidence of an association between dementia and adverse events or the length of hospital stay after adjusting for individual social and nursing care environment.