Elective Surgery in People with Dementia in Northern Ireland

Abstract

AbstractBackgroundElective care is defined as care that is planned in advance for those that require a procedure or treatment for an existing condition. Elective surgery aims to improve the physical or psychological quality of life for a patient and may extend the life of an individual. Evidence has shown that surgery in people with dementia (PwD) carry even more risk than those in the general ageing population particularly in terms of post‐operative complications and mortality rates. Whilst thousands of elective surgeries take place every year, it is unclear how many of these are conducted on PwD. This study explores the types and rates of elective surgery in PwD in Northern Ireland and the contributing factors to patient referral for elective surgery.MethodData was accessed through the Honest Broker Service (NI) and was retrospectively analysed. Dementia was defined in people who received one or more dementia medications (as outlined in the British National Formulary (BNF)) or when dementia was identified as a primary or secondary cause of death. Elective surgeries were identified by elective surgery referrals (Patient Administration System) (dementia cohort: n = 26,780; control: n = 24,056).ResultOverall, significantly less PwD were referred for an elective surgery compared to controls. Within the PwD group those who had higher odds to undergo an elective surgery were male, of younger age, lived in rural areas, did not transition to a care home, and were married instead of single or widowed. PwD were less likely to have an elective surgery if they received antipsychotics, but they were more likely to have a surgery if they received lipid lowering drugs, antihypertensives, hypnotics and anxiolytics, antidepressants, or antiarrhythmics. The most common surgeries from both PwD and controls were surgeries for lens, bladder and skin. Having an elective surgery was associated with lower odds of death for PwD and controls compared to people who did not undergo a surgery.ConclusionThis paper can inform health policy through insight into factors contributing to the rate and types of elective surgery referrals for PwD to ensure PwD are afforded the same care when it comes to elective surgery compared with the general population.