Journal Article

Dementia and patient outcomes after hip surgery in older patients: A retrospective observational study using nationwide administrative data in Japan

Fushimi, Kiyohide, Morioka, Noriko, Moriwaki, Mutsuko, Ogata, Yasuko, Tomio, Jun

2021

Overview

To investigate whether dementia is associated with incidence of adverse events and longer hospital stays in older adults who underwent hip surgery, after adjusting for individual social and nursing care environment. Retrospective observational study using the linked data between the Japanese Diagnosis Procedure Combination database and the reports of the medical functions of hospital beds database in Japan (April 2016-March 2017). A total of 48,797 individuals aged 65 and older who underwent hip surgery and were discharged during the study period. Outcomes included in-hospital death, in-hospital pneumonia, in-hospital fracture, and longer hospital stay. We performed two-level, multilevel models adjusting for individual and hospital characteristics. Among all participants, 20,638 individuals (42.3%) had dementia. The incidence of adverse events for those with and without dementia included in-hospital death: 2.11% and 1.11%, in-hospital pneumonia: 0.15% and 0.07%, and in-hospital fracture: 3.76% and 3.05%, respectively. The median (inter quartile range) length of hospital stay for those with and without dementia were 26 (19-39) and 25 (19-37) days, respectively. Overall, the odds ratios (95% confidence interval (CI)) of dementia for in-hospital death, in-hospital pneumonia, and in-hospital fracture were 1.12 (0.95-1.33), 0.95 (0.51-1.80), and 1.08 (0.92-1.25), respectively. Dementia was not associated with the length of hospital stay (% change) (-0.7%, 95% CI -1.6-0.3%). Admission from home, discharge to home, and lower nurse staffing were associated with prolonged hospital stays. Although adverse events are more likely to occur in older adults with dementia than in those without dementia after hip surgery, we found no evidence of an association between dementia and adverse events or the length of hospital stay after adjusting for individual social and nursing care environment.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Activities of daily living / Aged / Aged patients / Aged, 80 and over / Aging / Arthroplasty, Replacement, Hip - adverse effects / Biology and Life Sciences / Clinical outcomes / Comorbidity / Complications / Databases, Factual / Dementia / Dementia - epidemiology / Dementia disorders / Demographic aspects / Editing / Female / Fractures / Funding / Graduate schools / Graduate studies / Health care / Health policy / Health problems / Health services / Hip / Hospital Mortality / Hospitalization / Hospitals / Humans / Informatics / Japan - epidemiology / Joint replacement surgery / Joint surgery / Length of Stay / Long term health care / Long-term care / Male / Medicine / Medicine and Health Sciences / Monetary incentives / Mortality / Nurses / Nursing care / Observational studies / Older people / Patients / People and Places / Physiological aspects / Pneumonia / Postoperative Complications - epidemiology / Postoperative Complications - etiology / Psychological aspects / Public health / Retrospective Studies / Risk factors / Surgery / Surgical outcomes / Workforce planning