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Comparative outcomes for older adults undergoing surgery for bladder and bowel dysfunction.
J Am Geriatr Soc. 2021 08; 69(8):2210-2219.JA

Abstract

BACKGROUND/OBJECTIVES

To compare surgical outcomes between vulnerable nursing home (NH) residents and matched community-dwelling older adults undergoing surgery for bladder and bowel dysfunction.

DESIGN

Retrospective cohort study.

PARTICIPANTS

A total of 55,389 NH residents and propensity matched (based on procedure, age, sex, race, comorbidity, and year) community-dwelling older adults undergoing surgery for bladder and bowel dysfunction [female pelvic surgery, transurethral resection of the prostate, suprapubic tube placement, hemorrhoid surgery, rectal prolapse surgery]. Individuals were identified using Medicare claims and the Minimum Data Set (MDS) for NH residents between 2014 and 2016.

MEASUREMENTS

Thirty-day complications, 1-year mortality, and weighted changes in healthcare resource utilization (hospital admissions, emergency room visits, office visits) in the year before and after surgery.

RESULTS

NH residents demonstrated statistically significant increased risk of 30-day complications [60.1% v. 47.2%; RR 1.3 (95% CI 1.3-1.3)] and 1-year mortality [28.9% vs. 21.3%; RR 1.4 (95% CI 1.3-1.4)], compared to community-dwelling older adults. NH residents also demonstrated decreased healthcare resource utilization, compared to community-dwelling older adults, changing from 3.9 to 1.9 (vs.1.1 to 1.0) hospital admissions, 11 to 10.1 (vs. 9 to 9.7) office visits, and 3.4 to 2.2 (vs. 1.9 to 1.9) emergency room visits from the year before to after surgery.

CONCLUSION

Despite matching on several important clinical characteristics, NH residents demonstrated increased rates of 30-day complications and 1-year mortality after surgery for bowel and bladder dysfunction, while demonstrating decreased healthcare resource utilization. These mixed findings suggest that outcomes may be more varied among vulnerable older adults and warrant further investigation.

Links

PMC Free PDF

Authors+Show Affiliations

Suskind AM
Department of Urology, University of California, San Francisco, San Francisco, California, USA.
Zhao S
Department of Urology, University of California, San Francisco, San Francisco, California, USA.
Nik-Ahd F
Department of Urology, University of California, San Francisco, San Francisco, California, USA.
Boscardin WJ
Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA.
Covinsky K
Division of Geriatrics, University of California, San Francisco, San Francisco, California, USA.
Finlayson E
Department of Surgery, University of California, San Francisco, San Francisco, California, USA.

MeSH

AgedAged, 80 and overColorectal SurgeryFemaleHomes for the AgedHumansIndependent LivingMaleNursing HomesOutcome Assessment, Health CarePostoperative ComplicationsRetrospective StudiesUrologic Surgical Procedures

Pub Type(s)

Comparative Study
Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

33818753

Citation

Suskind, Anne M., et al. "Comparative Outcomes for Older Adults Undergoing Surgery for Bladder and Bowel Dysfunction." Journal of the American Geriatrics Society, vol. 69, no. 8, 2021, pp. 2210-2219.
Suskind AM, Zhao S, Nik-Ahd F, et al. Comparative outcomes for older adults undergoing surgery for bladder and bowel dysfunction. J Am Geriatr Soc. 2021;69(8):2210-2219.
Suskind, A. M., Zhao, S., Nik-Ahd, F., Boscardin, W. J., Covinsky, K., & Finlayson, E. (2021). Comparative outcomes for older adults undergoing surgery for bladder and bowel dysfunction. Journal of the American Geriatrics Society, 69(8), 2210-2219. https://doi.org/10.1111/jgs.17118
Suskind AM, et al. Comparative Outcomes for Older Adults Undergoing Surgery for Bladder and Bowel Dysfunction. J Am Geriatr Soc. 2021;69(8):2210-2219. PubMed PMID: 33818753.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparative outcomes for older adults undergoing surgery for bladder and bowel dysfunction. AU - Suskind,Anne M, AU - Zhao,Shoujun, AU - Nik-Ahd,Farnoosh, AU - Boscardin,W John, AU - Covinsky,Kenneth, AU - Finlayson,Emily, Y1 - 2021/04/05/ PY - 2021/01/27/revised PY - 2021/02/19/accepted PY - 2021/4/6/pubmed PY - 2022/4/24/medline PY - 2021/4/5/entrez SP - 2210 EP - 2219 JF - Journal of the American Geriatrics Society JO - J Am Geriatr Soc VL - 69 IS - 8 N2 - BACKGROUND/OBJECTIVES: To compare surgical outcomes between vulnerable nursing home (NH) residents and matched community-dwelling older adults undergoing surgery for bladder and bowel dysfunction. DESIGN: Retrospective cohort study. PARTICIPANTS: A total of 55,389 NH residents and propensity matched (based on procedure, age, sex, race, comorbidity, and year) community-dwelling older adults undergoing surgery for bladder and bowel dysfunction [female pelvic surgery, transurethral resection of the prostate, suprapubic tube placement, hemorrhoid surgery, rectal prolapse surgery]. Individuals were identified using Medicare claims and the Minimum Data Set (MDS) for NH residents between 2014 and 2016. MEASUREMENTS: Thirty-day complications, 1-year mortality, and weighted changes in healthcare resource utilization (hospital admissions, emergency room visits, office visits) in the year before and after surgery. RESULTS: NH residents demonstrated statistically significant increased risk of 30-day complications [60.1% v. 47.2%; RR 1.3 (95% CI 1.3-1.3)] and 1-year mortality [28.9% vs. 21.3%; RR 1.4 (95% CI 1.3-1.4)], compared to community-dwelling older adults. NH residents also demonstrated decreased healthcare resource utilization, compared to community-dwelling older adults, changing from 3.9 to 1.9 (vs.1.1 to 1.0) hospital admissions, 11 to 10.1 (vs. 9 to 9.7) office visits, and 3.4 to 2.2 (vs. 1.9 to 1.9) emergency room visits from the year before to after surgery. CONCLUSION: Despite matching on several important clinical characteristics, NH residents demonstrated increased rates of 30-day complications and 1-year mortality after surgery for bowel and bladder dysfunction, while demonstrating decreased healthcare resource utilization. These mixed findings suggest that outcomes may be more varied among vulnerable older adults and warrant further investigation. SN - 1532-5415 UR - https://www.unboundmedicine.com/medline/citation/33818753/Comparative_outcomes_for_older_adults_undergoing_surgery_for_bladder_and_bowel_dysfunction_ DB - PRIME DP - Unbound Medicine ER -