Incorporating Outcomes that Matter to Older Adults into Surgical Research

Cheung, Carling; Meissner, Matthew; Garg, Tullika

doi:10.1111/jgs.17028

Cited by 9 publications

(20 citation statements)

References 20 publications

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“…Older-adult surgical patients value quality of life over prolonged life and carefully consider the risk:benefit ratio of pursuing active treatment for major illnesses. 11 As well as the mortality risk, our results demonstrate an average in patient length of stay for survivors of 27 days (range 7-99) and average 9 days in intensive care (range 0-48). This is as important, as the mortality risk needs to be communicated to patients and their families so that they understand the expected treatment course.…”

Section: Discussionmentioning

confidence: 60%

“…Decline in functional status is considered more important than other outcomes for older adults, especially where it leads to loss of independence, and this is an important outcome that needs to be examined by future studies in colonic and mesenteric ischaemia. 11 We did not examine cases of mesenteric ischaemia in patients under the age of 65 years; however, a majority of cases will be in older adults, and younger adults will almost always be suitable candidates for intensive management, hence the value of preoperative prognostication is less. Overall, further work is required from general surgeons to develop on the risk-assessment tools we have and further improve them.…”

Section: Discussionmentioning

confidence: 99%

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NELA Risk Calculator Significantly Underestimates Mortality Risk of Laparotomy for Mesenteric and Colonic Ischaemia in Older Adult Surgical Patients

Connell¹

2023

OAS

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To establish if the NELA risk calculator underestimates mortality risk in older adults undergoing laparotomy for mesenteric or colonic ischaemia. Methods: A retrospective search of the operative database was performed for all patients over age 65 years who underwent laparotomy across two tertiary centres over a 3-year period. Cases of mesenteric or colonic ischaemia were identified from the operative records. Cases where ischaemia occurred secondarily to a primary obstructive or other pathology were excluded. Cases where a NELA score was not documented preoperatively were excluded. We then compared the NELA scores to the observed 30-day mortality rate. Secondary outcomes were hospital length of stay and intensive care unit length of stay. Results: Sixty cases were included in our analysis. There were 27 cases of colonic ischaemia and 33 cases of mesenteric ischaemia (mesenteric ischaemia group included five cases of distal small-bowel and colonic ischaemia). The overall mean NELA score was 21.9%, while the actual 30-day mortality was 43.3% (p=0.0094). Mean NELA score for mesenteric ischaemia cases only was 20.6% with an actual mortality rate of 45.5%. Mean NELA score for the colonic ischaemia cases was 23.5% with an actual mortality rate of 40.7%. The median time from operation to mortality was 8 days. Mean age was 77 years. Length of stay for survivors was a mean 27 days with intensive care unit length of stay of 9.3 days. Conclusion:The NELA risk score for mortality post-emergency laparotomy underestimates mortality risk by a factor of two in older adults where the primary pathology is mesenteric or colonic ischaemia.

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Section: Discussionmentioning

confidence: 60%

Section: Discussionmentioning

confidence: 99%

NELA Risk Calculator Significantly Underestimates Mortality Risk of Laparotomy for Mesenteric and Colonic Ischaemia in Older Adult Surgical Patients

Connell¹

2023

OAS

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“…Prior studies have reported the willingness of patients to decline life-prolonging treatments in order to avoid loss of independence and functional decline. 17 Although our study did not directly measure these endpoints, we feel that our measurement of likelihood of discharge to home or a higher level of care are similarly patient-centered and would be relevant to decision-making.…”

Section: Discussionmentioning

confidence: 99%

Patients living with dementia have worse outcomes when undergoing high‐risk procedures

Shah

Adler

Xiang

et al. 2022

J American Geriatrics Society

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Background Patients with Alzheimer's Disease and Related Dementias (ADRD) undergoing inpatient procedures represent a population at elevated risk for adverse outcomes including postoperative complications, mortality, and discharge to a higher level of care. Outcomes may be particularly poor in patients with ADRD undergoing high‐risk procedures. We sought to determine traditional (e.g., 30‐day mortality) and patient‐centered (e.g., discharge disposition) outcomes in patients with ADRD undergoing high‐risk inpatient procedures. Methods This retrospective cohort study analyzed electronic health records linked to fee‐for‐service Medicare claims data at a tertiary care academic health system. All patients from a large multi‐hospital health system undergoing high‐risk inpatient procedures from October 1, 2015 to September 30, 2017 with continuous Medicare Parts A and B enrollment in the 12 months prior to and 90 days following the procedure were included. Results This study included 6779 patients. 536 (7.9%) had ADRD. A multivariable analysis of outcomes demonstrated higher risks for postoperative complications (OR 1.49, 95% CI 1.23–1.81) and 90‐day mortality (OR 1.44 [95% CI 1.09–1.91]) in patients with ADRD compared to those without. Patients with ADRD were more likely to be discharged to a higher level of care (OR 1.70, 95% CI 1.32–2.18) and only 37.3% of patients admitted from home were discharged to home. Conclusions Compared to those without ADRD, patients living with ADRD undergoing high‐risk procedures have poor traditional and patient‐centered outcomes including increased risks for 90‐day mortality, postoperative complications, longer hospital lengths of stay, and discharge to a higher level of care. These data may be used by patients, their surrogates, and their physicians to help align surgical decision‐making with health care goals.

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“…Khanjan B. Shah MD, MPH 1 Samir K. Shah MD, MPH 2 Adoma Manful MPH 3 Lingwei Xiang MS 3 Amanda J. Reich PhD, MPH 3 Robert S. Semco BSE 3 Jennifer Tjia MD, MSCE 4 Keren Ladin PhD 5 Joel S. Weissman PhD 3 1…”

Section: Author Contributionsmentioning

confidence: 99%

Advance care planning billing codes in patients undergoing TAVR is infrequent and associated with adverse TAVR outcomes

Shah

Manful

et al. 2022

J American Geriatrics Society

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Incorporating Outcomes that Matter to Older Adults into Surgical Research

Abstract: This editorial comments on the article by https://doi.org/10.1111/jgs16907. in this issue.

Cited by 9 publications

References 20 publications

NELA Risk Calculator Significantly Underestimates Mortality Risk of Laparotomy for Mesenteric and Colonic Ischaemia in Older Adult Surgical Patients

NELA Risk Calculator Significantly Underestimates Mortality Risk of Laparotomy for Mesenteric and Colonic Ischaemia in Older Adult Surgical Patients

Patients living with dementia have worse outcomes when undergoing high‐risk procedures

Advance care planning billing codes in patients undergoing TAVR is infrequent and associated with adverse TAVR outcomes

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