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Postoperative Adverse Outcomes in Surgical Patients with Dementia: A Retrospective Cohort Study

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Abstract

Background

Dementia patients often present with coexisting medical conditions and potentially face higher risk of complications during hospitalization. Because the general features of postoperative adverse outcomes among surgical patients with dementia are unknown, we conducted a nationwide, retrospective cohort study to characterize surgical complications among dementia patients compared with sex- and age-matched nondementia controls.

Methods

Reimbursement claims from the Taiwan National Health Insurance Research Database were studied. A total of 18,923 surgical patients were enrolled with preoperative diagnosis of dementia for 207,693 persons aged 60 years or older who received inpatient major surgeries between 2004 and 2007. Their preoperative comorbidities were adjusted and risks for major surgical complications were analyzed.

Results

Dementia patients who underwent surgery had a significantly higher overall postoperative complication rate, adjusted odds ratio (OR) 1.79 (95 % confidence interval [CI] 1.72–1.86), with higher medical resources use, and in-hospital expenditures. Compared with controls, dementia patients had a higher incidence of certain postoperative complications that are less likely to be identified in their initial stage, such as: acute renal failure, OR = 1.32 (1.19–1.47); pneumonia, OR = 2.18 (2.06–2.31); septicemia, OR = 1.8 (1.69–1.92); stroke, OR = 1.51 (1.43–1.6); and urinary tract infection, OR = 1.62 (1.5–1.74).

Conclusions

These findings have specific implications for postoperative care of dementia patients regarding complications that are difficult to diagnose in their initial stages. Acute renal failure, pneumonia, septicemia, stroke, and urinary tract infection are the top priorities for prevention, early recognition, and intervention of postoperative complications among surgical patients with dementia. Further efforts are needed to determine specific protocols for health care teams serving this population.

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Acknowledgments

This research was supported by a Foundation for Anesthesia Education and Research fellowship grant, Taipei Medical University Hospital, without conflict of interest to be disclosed.

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Authors and Affiliations

  1. Department of Neurology, College of Medicine, Taipei Medical University, 250 Wuxing Street, Taipei, 110, Taiwan

    Chaur-Jong Hu

  2. Department of Anesthesiology, Taipei Medical University Hospital, 252 Wuxing Street, Taipei, 110, Taiwan

    Chien-Chang Liao, Chuen-Chau Chang & Ta-Liang Chen

  3. Department of Anesthesiology, College of Medicine, Taipei Medical University, 250 Wuxing Street, Taipei, 110, Taiwan

    Chien-Chang Liao, Chuen-Chau Chang & Ta-Liang Chen

  4. Department of Surgery, College of Medicine, Taipei Medical University, 250 Wuxing Street, Taipei, 110, Taiwan

    Chih-Hsiung Wu

  5. Department of Neurology, Taipei Medical University-Shuang Ho Hospital, 291, Jhongjheng Road, Jhonghe District, New Taipei City, Taiwan, ROC

    Chaur-Jong Hu & Chih-Hsiung Wu

Authors
  1. Chaur-Jong Hu
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  2. Chien-Chang Liao
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  3. Chuen-Chau Chang
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  4. Chih-Hsiung Wu
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  5. Ta-Liang Chen
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Correspondence to Ta-Liang Chen.

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Hu, CJ., Liao, CC., Chang, CC. et al. Postoperative Adverse Outcomes in Surgical Patients with Dementia: A Retrospective Cohort Study. World J Surg 36, 2051–2058 (2012). https://doi.org/10.1007/s00268-012-1609-x

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  • DOI: https://doi.org/10.1007/s00268-012-1609-x

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