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Mortality and Functional Outcomes After Minor Urological Surgery in Nursing Home Residents: A National Study.
J Am Geriatr Soc. 2018 05; 66(5):909-915.JA

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.

Authors+Show Affiliations

Department of Urology, University of California, San Francisco, San Francisco, California.Department of Urology, University of California, San Francisco, San Francisco, California.Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, California. Division of Geriatrics, Veterans Affairs Medical Center, San Francisco, California.Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California.Department of Surgery, University of California, San Francisco, San Francisco, California.

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

29572851

Citation

Suskind, Anne M., et al. "Mortality and Functional Outcomes After Minor Urological Surgery in Nursing Home Residents: a National Study." Journal of the American Geriatrics Society, vol. 66, no. 5, 2018, pp. 909-915.
Suskind AM, Zhao S, Walter LC, et al. Mortality and Functional Outcomes After Minor Urological Surgery in Nursing Home Residents: A National Study. J Am Geriatr Soc. 2018;66(5):909-915.
Suskind, A. M., Zhao, S., Walter, L. C., Boscardin, W. J., & Finlayson, E. (2018). Mortality and Functional Outcomes After Minor Urological Surgery in Nursing Home Residents: A National Study. Journal of the American Geriatrics Society, 66(5), 909-915. https://doi.org/10.1111/jgs.15302
Suskind AM, et al. Mortality and Functional Outcomes After Minor Urological Surgery in Nursing Home Residents: a National Study. J Am Geriatr Soc. 2018;66(5):909-915. PubMed PMID: 29572851.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Mortality and Functional Outcomes After Minor Urological Surgery in Nursing Home Residents: A National Study. AU - Suskind,Anne M, AU - Zhao,Shoujun, AU - Walter,Louise C, AU - Boscardin,W John, AU - Finlayson,Emily, Y1 - 2018/03/23/ PY - 2018/3/25/pubmed PY - 2019/9/14/medline PY - 2018/3/25/entrez KW - Medicare KW - Minimum Data Set (MDS) KW - frail KW - older adults SP - 909 EP - 915 JF - Journal of the American Geriatrics Society JO - J Am Geriatr Soc VL - 66 IS - 5 N2 - 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. SN - 1532-5415 UR - https://www.unboundmedicine.com/medline/citation/29572851/Mortality_and_Functional_Outcomes_After_Minor_Urological_Surgery_in_Nursing_Home_Residents:_A_National_Study_ DB - PRIME DP - Unbound Medicine ER -