Postoperative complications in Parkinson's disease.
BACKGROUND
Although Parkinson's disease is relatively common in America, with an average annual incidence of 20 cases per 100,000 population, little information exists about postoperative morbidity and mortality in those Parkinson's patients who undergo elective surgery.


METHODS
We performed a retrospective cohort study using the Veterans Affairs (VA) Austin database system (a cumulative index of admissions and discharges from all US VA Medical Centers) to identify 41,213 patients who underwent elective bowel resection, cholecystectomy, or radical prostatectomy between January 1, 1990, and December 31, 1995. We examined the study population using univariate analysis, acute length of stay with multivariate analysis, and postoperative complications with logistic regression.


RESULTS
The selected surgeries were performed on 234 patients with a diagnosis of Parkinson's disease and 40,979 with no such diagnosis. In univariate analysis, patients with Parkinson's disease had significantly longer acute hospital stays than non-Parkinson's patients (11.4 +/- 15.9 days vs 8.8 +/- 9.0 days, P < .001). In addition, Parkinson's patients had a higher in-hospital mortality than non-Parkinson's patients (7.3% vs 3.8%, P = .006). After we adjusted for coexisting morbidity, age, admitting location, and gender, patients with Parkinson's disease had an average acute hospital stay 2.34 days longer than that of non-Parkinson's patients (P < .001). However, the mortality difference did not reach statistical significance in multivariate analysis (P = .098). Finally, Parkinson's patients had significantly increased incidences of urinary-tract infection (odds ratio 2.045, P < .001), aspiration pneumonia (odds ratio 3.825, P < .001), and bacterial infections (odds ratio 1.682, P < .001).


CONCLUSIONS
Patients with Parkinson's disease are at greater risk for specific complications and longer hospital stay after elective bowel resection, cholecystectomy, or radical prostatectomy. Awareness of these complications may help caregivers to reduce postoperative mortality and morbidity and to decrease the length of hospitalization.
Pepper
P V
PV
Dept. of General Internal Medicine, Naval Medical Center San Diego, California 92134-5000, USA.
Goldstein
M K
MK
D000367:Age Factors; D000368:Aged; D000704:Analysis of Variance; D001424:Bacterial Infections / Q000453:epidemiology; D002763:Cholecystectomy / Q000009:adverse effects / Q000706:statistics & numerical data; D015331:Cohort Studies; D017558:Elective Surgical Procedures / Q000706:statistics & numerical data; D005260:Female; D017052:Hospital Mortality; D006787:Hospitals, Veterans / Q000706:statistics & numerical data; D006801:Humans; D007422:Intestines / Q000601:surgery; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010300:Parkinson Disease; D011015:Pneumonia, Aspiration / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology*; D011468:Prostatectomy / Q000009:adverse effects / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012737:Sex Factors; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs; D014552:Urinary Tract Infections / Q000453:epidemiology