Major Abdominal Surgery in Nursing Home Residents: A National Study

Annals of Surgery: December 2011 - Volume 254 - Issue 6 - p 921–926
doi: 10.1097/SLA.0b013e3182383a78
Finlayson, Emily MD emily.finlayson at ucsfmedctr.org *,†; Wang, Li PhD‡; Landefeld, C. Seth MD§,¶; Dudley, R. Adams MD†,**

Objective: To determine surgical risk in nursing home residents undergoing major abdominal surgery.

Background: Recent studies suggest that surgery can be performed safely in the very old. Surgical risk in nursing home residents is poorly understood.

Methods: We used national Medicare claims and the nursing home Minimum Data Set (1999–2006) to identify nursing home residents undergoing surgery (surgery for bleeding duodenal ulcer, cholecystectomy, appendectomy, and colectomy, n = 70,719). We compared operative mortality and use of invasive interventions (mechanical ventilation, intravascular hemodynamic monitoring, feeding tube placement, tracheostomy, and vena cava filters) among nursing home residents to rates among noninstitutionalized Medicare enrollees age 65 and older undergoing the same procedures. (n = 1,060,389). We adjusted for patient characteristics using logistic regression.

Results: Operative mortality among nursing home residents was substantially higher than among noninstitutionalized Medicare enrollees for all procedures (

• surgery for bleeding duodenal ulcer, 42% versus 26%, adjusted odds ratio (AOR) 1.79;
• colectomy, 32% versus 13%, AOR 2.06;
• appendectomy, 12% versus 2%, AOR 3.27;
• cholecystectomy, 11% versus 3%, AOR 2.65;

P < 0.001 for all comparisons). Overall, invasive interventions were more common among nursing home residents than controls (ranging from 18% and 5%, respectively, for cholecystectomy to 55% and 43%, respectively, for surgery for bleeding duodenal ulcer, P < 0.0001 for all comparisons).

Conclusions: Nursing home residents experience substantially higher rates of mortality and invasive interventions after major surgery than other Medicare beneficiaries that are independent of age and measured comorbidities. Our data suggest that the risks of major surgery are substantially higher in nursing home residents and this information should inform decisions of physicians and patients and their families.

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Observation by VtiaminDWiki: One of the many reasons that nursing home residents are not as robust as free living individuals is that they do not get outdoors as much, and are lacking the vitamin D needed for surgery

See also VitaminDWiki

• All items in Shut-in and Vitamin D 39 items
• Hospital stay 6 days longer for nursing home residents with low vitamin D – Oct 2011
• “Sunlight Officers” in some Australian senior facilities – Sept 2011
  encouraging the residents to spend more time in the sun, and get more vitamin D
• Dementia 19X more likely if low vitamin D – Jan 2012
• Elderly often trapped in vitamin D vicious circles especially in nursing homes
• All items in category After Surgery or Trauma
• 87 % of internal medicine patients were severely vitamin D deficient – Aug 2010
• Critical Care patients need vitamin D
  Summary of studies of ICU and Vitamin D levels as of Jan 2012

Year	ICU problem	If vitamin D less than
2011 this page	85 % increased death	20 ng
2011	85 % increased death	15 ng
2011	70 % increased death	15ng
2011	2X more likely to stay 2 days	20 ng

See also on web

• New York Times Blog on the article