|Title||High Burden of Palliative Care Needs of Older Adults During Emergency Major Abdominal Surgery.|
|Publication Type||Journal Article|
|Year of Publication||2018|
|Authors||Cooper, Z, Lilley, EJ, Bollens-Lund, E, Mitchell, SL, Ritchie, CS, Lipsitz, SR, Kelley, AS|
|Journal||J Am Geriatr Soc|
|Date Published||2018 11|
|Keywords||Abdomen, Aged, Aged, 80 and over, Emergency Service, Hospital, Female, Hospitalization, Humans, Insurance Claim Review, Intensive Care Units, Intraoperative Complications, Male, Medicare, Mortality, Palliative care, Patient Acceptance of Health Care, Retrospective Studies, Time Factors, United States|
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.
|User Guide Notes|
|Short Title||J Am Geriatr Soc|
|Alternate Journal||J Am Geriatr Soc|
|PubMed Central ID||PMC6494102|
|Grant List||P30AG044281 / AG / NIA NIH HHS / United States |
R18HS022763 / / Agency for Healthcare Research and Quality / International
/ / American Federation for Aging Research / International
/ / Cambia Foundation / International
K76 AG054859 / AG / NIA NIH HHS / United States
K23-AG040774 / AG / NIA NIH HHS / United States
1K76AG054859-01 / / Paul B. Beeson Emerging Leaders Career Development Award in Aging / International
R01NR014656 / / National Institute for Nursing Research / International
U24NR014637 / / National Institute for Nursing Research / International
/ / National Palliative Care Research Center / International
K24AG033640 / AG / NIA NIH HHS / United States
R21NR015264 / / National Institute for Nursing Research / International