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

Woubet Tefera Kassahun

doi:10.1186/s12877-018-0844-x

Abstract

BackgroundThe aim was to assess the morbidity and in-hospital mortality that occur in surgical patients with pre-existing dementia compared with those outcomes in non-dementia patients following emergent and nonemergent general surgical operations.MethodsA total of 120 patients with dementia were matched for sex and type of surgery with 120 patients who did not have dementia, taken from a cohort of 15,295 patients undergoing surgery, in order to assess differences in surgical risk with dementia. Patient information was examined, including sex, body mass index (BMI), prevalence of individual comorbidities at admission, and several other variables that may be associated with postoperative outcomes as potential confounders.ResultsPatients with dementia tended to have a higher overall complication burden compared to those without. This was evidenced by a higher average number of complications per patient (3.30 vs 2.36) and a higher average score on the comprehensive complication index (48.61 vs 37.60), values that were statistically significant for a difference between the two groups. The overall in-hospital mortality in patients with dementia was 28.3% (34 deaths out of 120 patients). During the same period, at our hospital, the overall in-hospital mortality in the control group was 20% (24 deaths out of 120 patients). Patient groups with and without dementia each had 3 and 5 associated risk factors for morbidity and 9 and 12 risk factors for mortality, respectively.ConclusionsPatients with pre-existing dementia have a greater than average risk of early death after surgery, and their incidence of fatal complications is higher than that of surgical patients without dementia.

Highlights

The aim was to assess the morbidity and in-hospital mortality that occur in surgical patients with pre-existing dementia compared with those outcomes in non-dementia patients following emergent and nonemergent general surgical operations
The current study reports the relationship between pre-existing dementia and postoperative outcomes
Stratification by diagnosis yielded 120 patients with pre-existing dementia and a female predominance for undergoing elective and emergent operations in general and vascular surgery. These patients were matched for sex and type of surgery with 120 patients who did not have dementia with a relatively similar distribution of patient characteristics and surgical variables

Summary

Introduction

The aim was to assess the morbidity and in-hospital mortality that occur in surgical patients with pre-existing dementia compared with those outcomes in non-dementia patients following emergent and nonemergent general surgical operations. The population aged 80 and older is expected to increase from 126.5 million in 2015 to 446.6 million in 2050 [3].This means that as Surgical procedures in patients with dementia carry a significant risk of complications and have a high. In one recent study [5], surgical mortality for the patient with dementia was 13% in 30 days, increasing with time to as high as 92% in two years, compared with a surgical mortality rate of less than 7% for those without dementia [6, 7]. Accurate preoperative risk stratification can be difficult because pre-existing dementia that contributes to the early death of such patients is a non-modifiable factor. The treatment of choice for this group of patients is difficult to determine

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Conclusion