The effects of pre-existing dementia on surgical outcomes in emergent and nonemergent general surgical procedures: assessing differences in surgical risk with dementia

Kassahun, Woubet Tefera

doi:10.1186/s12877-018-0844-x

Cited by 52 publications

(34 citation statements)

References 26 publications

(28 reference statements)

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“…Preoperative sepsis is an easily assessed preoperative factor; however, it might not be a chronic preoperative comorbidity. Similarly, previous studies also indicated that patients with preexisting dementia exhibit a high risk of early mortality after surgery, and their incidence of fatal complications was higher than that of surgical patients without dementia, although surgery was not specifically a pancreaticoduodenectomy. Patients with preoperative dementia usually show low activity and poor self‐sufficiency, which increase postoperative complications, such as surgical site infection, urinary tract infections, and respiratory complications .…”

Section: Discussionmentioning

confidence: 73%

“…The majority of these risk factors were associated with perioperative morbidity or mortality in previous studies on pancreatic resection results . Overall morbidity after a pancreaticoduodenectomy associated with 90‐day mortality included preoperative factors that are considered risk factors for superficial and deep surgical site infection, pneumonia, unplanned intubation, renal insufficiency, and urinary tract infections . COPD is a crucial patient‐related risk factor for postoperative pulmonary complications .…”

Section: Discussionmentioning

confidence: 98%

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Age comorbidity scores as risk factors for 90‐day mortality in patients with a pancreatic head adenocarcinoma receiving a pancreaticoduodenectomy: A National Population‐Based Study

et al. 2019

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Background:To estimate easily assessed preoperative factors for predicting 90day mortality in patients with a pancreatic head adenocarcinoma (PHA) receiving a pancreaticoduodenectomy. Methods: We analyzed data from the Taiwan Cancer Registry Database of patients with a PHA who received a pancreaticoduodenectomy. Basic demographic characteristics, including gender and age, were categorized. The selection of preoperative comorbidities was based on the preoperative American Society of Anesthesiologists score and Charlson comorbidity index. Results: We enrolled 8490 patients with a PHA who received a pancreaticoduodenectomy without distant metastasis. Currently, a pancreaticoduodenectomy for a PHA achieves an overall 90-day mortality rate of 8.39%. Univariate and multivariate Cox regression analyses indicated that an older age (65-74 and ≥75 years) and specific comorbidities (chronic obstructive pulmonary disease, chronic kidney disease, dementia, and sepsis) were significant independent prognostic factors for predicting 90-day mortality after a pancreaticoduodenectomy. After adjustment, the adjusted 572 |

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Section: Discussionmentioning

confidence: 73%

Section: Discussionmentioning

confidence: 98%

Age comorbidity scores as risk factors for 90‐day mortality in patients with a pancreatic head adenocarcinoma receiving a pancreaticoduodenectomy: A National Population‐Based Study

et al. 2019

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“…44,45 Patients with mild cognitive impairment or dementia are at twofold higher risk of developing postoperative delirium as well as other adverse outcomes. 42,46 Therefore, we believe cognitive status is a critical component of any preoperative evaluation, and based on our analysis, we recommend more granular data regarding cognition be included in VQI data collection to help preoperative assessment and future quality improvement efforts.…”

Section: Discussionmentioning

confidence: 92%

Variation in center-level frailty burden and the impact of frailty on long-term survival in patients undergoing elective repair for abdominal aortic aneurysms

George

Chen

Trickey

et al. 2020

Journal of Vascular Surgery

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Objective: Frailty is increasingly recognized as a key determinant in predicting postoperative outcomes. Centers that see more frail patients may not be captured in risk adjustment, potentially accounting for poorer outcomes in hospital comparisons. We aimed to (1) determine the effect of frailty on long-term mortality in patients undergoing elective abdominal aortic aneurysm (AAA) repair and (2) evaluate the variability in frailty burden among centers in the Vascular Quality Initiative (VQI) database. Methods:Patients undergoing elective open and endovascular AAA repair (2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016)(2017) were identified, and those with complete data on component variables of the VQI-derived Risk Analysis Index (VQI-RAI) and centers with $10 AAA repairs were included. VQI-RAI characteristics are sex, age, body mass index, renal failure, congestive heart failure, dyspnea, preoperative ambulation, and functional status. Frailty was defined as VQI-RAI $35 based on prior work in surgical patients using other quality improvement databases. This corresponds to the top 12% of patients at risk in the VQI. Center-level VQI-RAI differences were assessed by analysis of variance test. Relationships between frailty and survival were compared by Kaplan-Meier analysis and the log-rank test for open and endovascular procedures. Multivariable hierarchical Cox proportional hazards regression models were calculated with random intercepts for center, controlling for frailty, race, insurance, AAA diameter, procedure type, AAA case mix, and year.Results: A total of 15,803 patients from 185 centers were included. Mean VQI-RAI scores were 27.6 (standard deviation, 5.9; range, 4-56) and varied significantly across centers (F ¼ 2.41, P < .001). The percentage of frail patients per center ranged from 0% to 40.0%. In multivariable analysis, frailty was independently associated with long-term mortality (hazard ratio, 2.88; 95% confidence interval, 2.6-3.2) after accounting for covariates and center-level variance. Open AAA repair was not associated with long-term mortality after adjusting for frailty (hazard ratio, 0.98; 95% confidence interval, 0.86-1.13). There was a statistically significant difference in the percentage of frail patients compared with nonfrail patients who were discharged to a rehabilitation facility or nursing home after both open (40.5% vs 17.8%; P < .0001) and endovascular repair (17.7% vs 4.6%; P < .0001). Conclusions:There is considerable variability of preoperative frailty among VQI centers performing elective AAA repair. Adjusting for center-level variation, frailty but not procedure type had a significant association with long-term mortality; however, frailty and procedure type were both associated with nonhome discharge. Routine measurement of frailty preoperatively by centers to identify high-risk patients may help mitigate procedural and long-term outcomes and improve shared decision-making regarding AAA repair. (J Vasc Surg 2020;71:46-55.)

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“…Also in our present findings, we observed a frequent presence of dementia in the non-survivors group. It is reported that dementia is related to the incidence of surgical site infection, postoperative delirium, and pneumonia; therefore, dementia itself is considered to be one of the risk factors of surgical outcomes [27]. On the other hand, dementia is reported to be an independent risk factor for malnutrition and the odds ratio is noted to be 2.14 (p = 0.001) [28].…”

Section: Discussionmentioning

confidence: 99%

Geriatric Nutritional Risk Index and Controlling Nutritional Status Score can predict postoperative 180-day mortality in hip fracture surgeries

Kotera

2019

JA Clin Rep

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Background: The Geriatric Nutritional Risk Index (GNRI) based on serum albumin level and body weight and the Controlling Nutritional Status Score (CONUT) based on serum albumin level, total cholesterol level, and total lymphocyte count were created to evaluate objectively a patient's nutritional status in 2005. Here we validated the usefulness of the GNRI and the CONUT as a prognostic factor of the 180-day mortality in patients who underwent hip fracture surgeries. We retrospectively collected data from patients with hip surgeries performed from January 2012 to December 2018. The variables required for the GNRI and the CONUT and the factors presumably associated with postoperative mortality including the patients' characteristics were collected from the medical charts. Intergroup differences were assessed with the χ 2 test with Yates' correlation for continuity in category variables. The Mann-Whitney U test was used to test for differences in continuous variables. We validated the power of the GNRI and the CONUT values to distinguish patients who died ≤ 180 days post-surgery from those who did not, by calculating the area under the receiver operating characteristic curve (AUC). The correlation between these two models was analyzed by Spearman's rank correlation (ρ). Results: We retrospectively examined the cases of 607 patients aged 87 ± 6 (range 70-102) years old. The 180-day mortality rate was 5.4% (n = 33 non-survivors). The GNRI value in the non-survivors was 83 ± 9 (range 66-111), which was significantly lower than that in the survivors at 92 ± 9 (range 64-120). The CONUT value in the nonsurvivors was 6 ± 3 (range 1-11), which was significantly higher than that in the survivors at 4 ± 2 (range 0-11). The AUC value to predict the 180-day mortality was 0.74 for the GNRI and 0.72 for the CONUT. The ρ value between these two models was 0.61 in the total of 607 patients and was 0.78 in the 33 non-survivors. Conclusions: Our results suggest that the GNRI and the CONUT are a simple and useful tool to predict the 180day mortality in patients who have undergone a hip surgery.

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The effects of pre-existing dementia on surgical outcomes in emergent and nonemergent general surgical procedures: assessing differences in surgical risk with dementia

Cited by 52 publications

References 26 publications

Age comorbidity scores as risk factors for 90‐day mortality in patients with a pancreatic head adenocarcinoma receiving a pancreaticoduodenectomy: A National Population‐Based Study

Age comorbidity scores as risk factors for 90‐day mortality in patients with a pancreatic head adenocarcinoma receiving a pancreaticoduodenectomy: A National Population‐Based Study

Variation in center-level frailty burden and the impact of frailty on long-term survival in patients undergoing elective repair for abdominal aortic aneurysms

Geriatric Nutritional Risk Index and Controlling Nutritional Status Score can predict postoperative 180-day mortality in hip fracture surgeries

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