Abstract
Background
When patients with dementia develop acute surgical abdomen, patients, surrogates,
and surgeons need accurate prognostic information to facilitate goal-concordant decision
making. Palliative care can assist with communication, symptom management, and family
and caregiver support in this population. We aimed to characterize outcomes and patterns
of palliative care utilization among patients with dementia, presenting with abdominal
surgical emergency.
Method
We retrospectively queried the National Inpatient Sample for patients aged >50 years
with dementia and acute abdominal emergency who were admitted nonelectively 2009–2013,
utilizing ICD-9-CM codes for dementia and surgical indication. We characterized outcomes
and identified predictors of palliative care utilization.
Results
Among 15,209 patients, in-hospital mortality was 10.2%, the nonroutine discharge rate
was 67.2%, and 7.5% received palliative care. Patients treated operatively were less
likely to receive palliative care than those who did not undergo operation (adjusted
OR = 0.50; 95% CI 0.41–0.62). Only 6.4% of patients discharged nonroutinely received
palliative care.
Conclusion
Patients with dementia and acute abdominal emergency have considerable in-hospital
mortality, a high frequency of nonroutine discharge, and low palliative care utilization.
In this group, we discovered a large gap in palliative care utilization, particularly
among those treated operatively and those who are discharged nonroutinely.
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Article info
Publication history
Published online: December 04, 2017
Accepted:
September 16,
2017
Footnotes
Funded by the Rutgers New Jersey Medical School Department of Surgery. Additional funding provided by the New Jersey Medical School Hispanic Center of Excellence, Health Resources and Services Administration through Grant D34HP26020 (Dr Berlin).
Presented at the 12th Annual Academic Surgical Congress.
Identification
Copyright
© 2017 Elsevier Inc. All rights reserved.
