High Burden of Palliative Care Needs of Older Adults During Emergency Major Abdominal Surgery.

Autor: Cooper Z; The Center for Surgery and Public Health, Boston, Massachusetts.; Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts.; Hebrew Senior Life, Boston, Massachusetts., Lilley EJ; The Center for Surgery and Public Health, Boston, Massachusetts.; Department of Surgery, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey., Bollens-Lund E; Icahn School of Medicine at Mount Sinai, New York, New York., Mitchell SL; Hebrew Senior Life Institute for Aging Research, Boston, Massachusetts.; Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts., Ritchie CS; Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, California., Lipstiz SR; The Center for Surgery and Public Health, Boston, Massachusetts.; Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts., Kelley AS; Icahn School of Medicine at Mount Sinai, New York, New York.; James J. Peters Veterans Affairs Medical Center, Bronx, New York.
Jazyk: angličtina
Zdroj: Journal of the American Geriatrics Society [J Am Geriatr Soc] 2018 Nov; Vol. 66 (11), pp. 2072-2078. Date of Electronic Publication: 2018 Sep 24.
DOI: 10.1111/jgs.15516
Abstrakt: Objectives: To quantify preoperative illness burden in older adults undergoing emergency major abdominal surgery (EMAS), to examine the association between illness burden and postoperative outcomes, and to describe end-of-life care in the year after discharge.
Design: Retrospective study using data from Health and Retirement Study interviews linked to Medicare claims (2000-2012).
Setting: National population-based dataset.
Participants: Medicare beneficiaries who underwent EMAS.
Measurements: High illness burden, defined as ≥2 of the following vulnerabilities: functional dependence, dementia, use of helpers, multimorbidity, poor prognosis, high healthcare utilization. In-hospital outcomes were complications and mortality. Postdischarge outcomes included emergency department (ED) visits, hospitalization, intensive care unit (ICU) stay, and 365-day mortality. For individuals discharged alive who died within 365 days of surgery, outcomes included hospice use, hospitalization, ICU use, and ED use in the last 30 days of life. Multivariable regression was used to determine the association between illness burden and outcomes.
Results: Of 411 participants, 57% had high illness burden. More individuals with high illness burden had complications (45% vs 28% p=0.00) and in-hospital death (20% vs 9%, p=0.00) than those without. After discharge (n=349), individuals with high illness burden experienced more ED visits (57% vs 46%, P=.04) and were more likely to die (35% vs 13%, p=0.00). Of those who died after discharge (n=86), 75% had high illness burden, median survival was 67 days (range 21-141 days), 48% enrolled in hospice, 32% died in the hospital, 23% were in the ICU in the last 30 days of life and 37% had an ED visit in the last 30 days of life.
Conclusion: Most older adults undergoing EMAS have preexisting high illness burden and experience high mortality and healthcare use in the year after surgery, particularly near the end of life. Concurrent surgical and palliative care may improve quality of life and end-of-life care in these people. J Am Geriatr Soc 66:2072-2078, 2018.
(© 2018, Copyright the Authors Journal compilation © 2018, The American Geriatrics Society.)
Databáze: MEDLINE
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