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Functional and cognitive outcomes after suprapubic catheter placement in nursing home residents: A national cohort study.
J Am Geriatr Soc. 2022 10; 70(10):2948-2957.JA

Abstract

BACKGROUND

Long-term functional and cognitive outcomes in nursing home residents after procedures are poorly understood. Our objective was to evaluate these outcomes after suprapubic tube (SPT) placement.

METHODS

We performed a retrospective, cohort study in the nursing home setting. Participants were long-term nursing home residents who underwent SPT placement from 2014 to 2016 in the United States. SPT placements were identified in Medicare Inpatient, Outpatient, and Carrier files using International Classification of Diseases and Current Procedural Terminology codes. Residents were identified through the Minimum Data Set (MDS) 3.0 for Nursing Home Residents. MDS Activities of Daily Living (MDS-ADL) and Brief Interview for Mental Status (BIMS) scores were used to assess function and cognition, respectively. Outcomes of interest were worsening MDS-ADL and BIMS scores at 1 year postoperatively, 30-day postoperative complications, and 1-year mortality. Functional and cognitive trajectories were modeled to 1 year postoperatively using mixed-effect spline models.

RESULTS

From 2014 to 2016, 9647 residents with a mean age of 80.9 (SD 8.1) years underwent SPT placement. At 1 year postoperatively, 37.6% of residents died, while of survivors, 33.7% had worsening MDS-ADL and 36.2% worsened BIMS. Residents had steeper postoperative rates of functional decline compared to relatively stable preoperative trends that never recovered to baseline status. However, robustly characterizing an association between SPT placement and functional decline would require a propensity score matched cohort without SPT placement. Decline in cognitive status was not clearly associated with SPT placement, suggesting either the natural course of a vulnerable population or limitations of BIMS scores.

CONCLUSIONS

Outcomes important to older adults, such as functional ability and cognitive status, do not show improvement after SPT placement. These findings emphasize that this "minor" procedure should be considered with caution in this population and primarily for palliation.

Links

Publisher Full Text (DOI)

Authors+Show Affiliations

Chou WH
Harvard Medical School, Boston, Massachusetts, United States.
Covinsky K
Division of Geriatrics, University of California San Francisco, San Francisco, California, United States.
Zhao S
Department of Urology, University of California San Francisco, San Francisco, California, United States.
Boscardin WJ
Division of Geriatrics, University of California San Francisco, San Francisco, California, United States.
Finlayson E
Department of Surgery, University of California San Francisco, San Francisco, California, United States.
Suskind AM
Department of Urology, University of California San Francisco, San Francisco, California, United States.

MeSH

Activities of Daily LivingAgedAged, 80 and overCathetersCognitionCohort StudiesHumansMedicareNursing HomesRetrospective StudiesUnited States

Pub Type(s)

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

Language

eng

PubMed ID

35696283

Citation

Chou, Wesley H., et al. "Functional and Cognitive Outcomes After Suprapubic Catheter Placement in Nursing Home Residents: a National Cohort Study." Journal of the American Geriatrics Society, vol. 70, no. 10, 2022, pp. 2948-2957.
Chou WH, Covinsky K, Zhao S, et al. Functional and cognitive outcomes after suprapubic catheter placement in nursing home residents: A national cohort study. J Am Geriatr Soc. 2022;70(10):2948-2957.
Chou, W. H., Covinsky, K., Zhao, S., Boscardin, W. J., Finlayson, E., & Suskind, A. M. (2022). Functional and cognitive outcomes after suprapubic catheter placement in nursing home residents: A national cohort study. Journal of the American Geriatrics Society, 70(10), 2948-2957. https://doi.org/10.1111/jgs.17928
Chou WH, et al. Functional and Cognitive Outcomes After Suprapubic Catheter Placement in Nursing Home Residents: a National Cohort Study. J Am Geriatr Soc. 2022;70(10):2948-2957. PubMed PMID: 35696283.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Functional and cognitive outcomes after suprapubic catheter placement in nursing home residents: A national cohort study. AU - Chou,Wesley H, AU - Covinsky,Kenneth, AU - Zhao,Shoujun, AU - Boscardin,W John, AU - Finlayson,Emily, AU - Suskind,Anne M, Y1 - 2022/06/13/ PY - 2022/05/11/revised PY - 2022/02/11/received PY - 2022/05/15/accepted PY - 2023/10/01/pmc-release PY - 2022/6/14/pubmed PY - 2022/10/19/medline PY - 2022/6/13/entrez KW - cognition KW - functional status KW - nursing homes KW - urinary catheters SP - 2948 EP - 2957 JF - Journal of the American Geriatrics Society JO - J Am Geriatr Soc VL - 70 IS - 10 N2 - BACKGROUND: Long-term functional and cognitive outcomes in nursing home residents after procedures are poorly understood. Our objective was to evaluate these outcomes after suprapubic tube (SPT) placement. METHODS: We performed a retrospective, cohort study in the nursing home setting. Participants were long-term nursing home residents who underwent SPT placement from 2014 to 2016 in the United States. SPT placements were identified in Medicare Inpatient, Outpatient, and Carrier files using International Classification of Diseases and Current Procedural Terminology codes. Residents were identified through the Minimum Data Set (MDS) 3.0 for Nursing Home Residents. MDS Activities of Daily Living (MDS-ADL) and Brief Interview for Mental Status (BIMS) scores were used to assess function and cognition, respectively. Outcomes of interest were worsening MDS-ADL and BIMS scores at 1 year postoperatively, 30-day postoperative complications, and 1-year mortality. Functional and cognitive trajectories were modeled to 1 year postoperatively using mixed-effect spline models. RESULTS: From 2014 to 2016, 9647 residents with a mean age of 80.9 (SD 8.1) years underwent SPT placement. At 1 year postoperatively, 37.6% of residents died, while of survivors, 33.7% had worsening MDS-ADL and 36.2% worsened BIMS. Residents had steeper postoperative rates of functional decline compared to relatively stable preoperative trends that never recovered to baseline status. However, robustly characterizing an association between SPT placement and functional decline would require a propensity score matched cohort without SPT placement. Decline in cognitive status was not clearly associated with SPT placement, suggesting either the natural course of a vulnerable population or limitations of BIMS scores. CONCLUSIONS: Outcomes important to older adults, such as functional ability and cognitive status, do not show improvement after SPT placement. These findings emphasize that this "minor" procedure should be considered with caution in this population and primarily for palliation. SN - 1532-5415 UR - https://www.unboundmedicine.com/medline/citation/35696283/Functional_and_cognitive_outcomes_after_suprapubic_catheter_placement_in_nursing_home_residents:_A_national_cohort_study_ DB - PRIME DP - Unbound Medicine ER -