Colorectal Surgery Outcomes and Healthcare Burden for Medicare Beneficiaries With Dementia

Abstract

Introduction

Patients with Alzheimer's disease and related dementias (ADRD) undergoing colorectal surgery have suboptimal postoperative outcomes, but the specific adverse outcomes and the context of these worse outcomes on a national level are not well understood.

Methods

Colorectal surgery patients with and without ADRD from January 1, 2017, to October 1, 2018, were identified using traditional, fee-for-service Medicare claims data. Unadjusted and adjusted analyses were performed to evaluate postoperative outcomes.

Results

123,324 Medicare beneficiaries (mean age 76.5, 59.3% female) underwent colorectal surgery in the study cohort with 8.3% (n = 10,254) having a preoperative diagnosis of ADRD. Colorectal surgery patients with ADRD were older (81 versus 76 y old, P < 0.001), frail (42.8% versus 13.6%, P < 0.001), and had more comorbidities (Elixhauser Score 19.6 versus 13.9, P < 0.001) compared with those without an ADRD diagnosis. Patients with ADRD more often had open surgery (75.2% versus 65.7%, P < 0.001) and emergency surgery (65.1% versus 37.8%, P < 0.001). Unadjusted and adjusted analyses demonstrated that patients with ADRD have an increased risk of in-hospital, 30-d, and 90-day mortality, as well as postoperative complications. Patients with ADRD required more healthcare resources after colorectal surgery including increased length of stay (7 versus 5 days), discharge to a higher level of care (60.8% versus 25.8%, P < 0.001), and discharge to a facility (54.0% versus 23.8%, P < 0.001).

Conclusions

For patients undergoing colorectal surgery, the diagnosis of ADRD is an independent risk factor for adverse postoperative outcomes and results in increased healthcare resource utilization both in hospital and after discharge.