Nursing home residents face greater surgery risks
NEW YORK (Reuters Health) - Elderly nursing home residents may suffer more complications from major operations than other people their age, a new study finds.
For example, 12 out of 100 nursing home residents who had their appendix removed died within a month of the procedure, compared to just two out of 100 elderly people living on their own.
That's despite the fact that this surgery is generally considered "low-risk."
"We may be too aggressive with surgery in nursing home residents," said lead researcher Dr. Emily Finlayson, who specializes in gastrointestinal surgery at the University of California in San Francisco.
"They are frail and often have advanced medical problems, which put them at high risk of dying after surgery."
The new study, published in the Annals of Surgery, is based on more than 70,000 nursing home residents and 1 million non-institutionalized Medicare enrollees 65 years and older.
Finlayson's team looked at the number of people who died from abdominal surgery, including removal of the gall bladder, appendix or colon, or surgery for bleeding ulcers.
The death rates were consistently higher among people in nursing homes.
After surgery for bleeding ulcers, for instance, 42 percent died, whereas 26 percent of the community-dwelling elderly died. For colon surgery, the figures were 32 percent and 13 percent, respectively.
In 2009, there were 1.4 million nursing home residents in the U.S., according to the Centers for Disease Control and Prevention. While they currently receive standard surgical care in the U.S., Finlayson said alternative therapies -- such as using antibiotics for gall bladder infections -- need to be considered.
"We need to be more flexible with how we treat these patients so they don't face the dangerous risks associated with surgery," she told Reuters Health.
Her team also found that substantially more nursing home residents needed extra treatment as a result of their operation.
"Patients who survived had to go undergo invasive procedures after surgery which means more time on the ventilator, more people getting feeding tubes, and more time in the ICU," said Finlayson.
The gaps in death rates remained even after the researchers took age, sex and other ailments people might have into account.
Still, some differences between the two groups of older people might have been hard to eliminate.
"Nursing home patients in this study were likely on average a higher risk surgical group," cautioned Dr. Nader Massarweh in an email to Reuters Health.
"That makes it difficult to pick out the effect that being older and sicker has on surgical outcomes because the majority of patients in that group were older and sicker," Massarweh, who studies surgical outcomes at the University of Washington in Seattle, said.
But he agreed the new findings should be shared with patients.
"We can use this data when talking with patients or their families about the risks of surgical intervention versus not performing surgery," he said. "I think having an informed discussion is the best course of action."
SOURCE: bit.ly/vOYSnj Annals of Surgery, October 20, 2011.
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