Dementia Patients Have Poorer Surgery Outcomes, Including Increased Mortality

Dementia patients undergoing common surgical procedures may be at greater risk of in-hospital mortality, non-home discharge, and longer hospital length of stay (LOS), according to new research.

“Dementia is associated with poor outcomes after surgical procedures. However, the types of major surgical procedures commonly performed in older adults with dementia and the surgical outcomes have not been characterized in a national sample,” explained the researchers.

The study authors collected data from the Premier Healthcare Database, which houses about a quarter of U.S. inpatient admissions, on adults aged 65 years and older who underwent major surgical procedures between Jan. 1, 2016, and March 31, 2018. The Chronic Conditions Data Warehouse algorithm was used to define dementia. Analyses were performed comparing patients with versus without dementia, adjusting for age, sex, race, admission source, Charlson Comorbidity Index, and procedure type, comparing the top 10 procedures combined and separately.

Dementia Patients: Increased Mortality, LOS, Less Likely to Discharge Home

A total of 164,551 patients with dementia and 2,320,668 patients without underwent surgery at 804 different hospitals. Dementia patients, compared to those without, tended to be older (mean [SD] age, 81 [7] vs. 74 [7] years) and were more likely to be women (57.4% vs. 50.9%) or African American (9.7% vs. 7.0%) or have undergone an emergent operation (60.8% vs. 25.8%). A similar rate of patients with versus without dementia underwent surgery at teaching hospitals (48.0% vs. 47.3%) and urban hospitals (89.2% vs. 89.8%). Overall, 6.4% of surgical procedures were performed in dementia patients. In the dementia group, the most common surgical procedure was hip or femur repair (16.5%); among patients without, it was knee arthroplasty (8.6%).

In adjusted analyses, dementia patients, compared to those without undergoing the same procedure, had a higher in-hospital mortality rate (odds ratio [OR], 1.15; 95% confidence interval [CI], 1.10 to 1.20), lower home discharge rate (OR, 0.30; 95% CI, 0.29 to 0.31), and longer LOS (mean difference, 2.35 days; 95% CI, 2.13 days to 2.57 days). When looking at specific procedures, for dementia patients being treated for fracture or dislocation of the hip and femur, compared to patients without dementia, the OR for in-hospital mortality was 1.16 (95% CI, 1.05 to 1.27) and for home discharge was 0.66 (95% CI, 0.62 to 0.70); the mean difference in hospital LOS was 0.24 days (95% CI, 0.18 to 0.30). For total or partial hip replacement, the ORs for in-hospital mortality and home discharge for dementia patients versus those without dementia were 1.41 (95% CI, 1.22 to 1.63) and 0.19 (95% CI, 0.18 to 0.21), respectively; the mean difference in LOS was 1.21 days (95% CI, 1.13 to 1.30).

The study was published in JAMA Network Open.

“Once the decision is made to proceed with surgical procedures, comanagement that includes both the geriatrics and the surgery departments can be beneficial. Our results can be useful to prioritize surgical procedures in which development of a comanagement program is necessary,” the researchers recommended.