title: Postoperative adverse outcomes in intellectually disabled surgical patients: a nationwide population-based study.
abstract: BACKGROUND
  Intellectually disabled patients have various comorbidities, but their risks of adverse surgical outcomes have not been examined. This study assesses pre-existing comorbidities, adjusted risks of postoperative major morbidities and mortality in intellectually disabled surgical patients.
  
  
  METHODS
  A nationwide population-based study was conducted in patients who underwent inpatient major surgery in Taiwan between 2004 and 2007. Four controls for each patient were randomly selected from the National Health Insurance Research Database. Preoperative major comorbidities, postoperative major complications and 30-day in-hospital mortality were compared between patients with and without intellectual disability. Use of medical services also was analyzed. Adjusted odds ratios using multivariate logistic regression analyses with 95% confidence intervals were applied to verify intellectual disability's impact.
  
  
  RESULTS
  Controls were compared with 3983 surgical patients with intellectual disability. Risks for postoperative major complications were increased in patients with intellectual disability, including acute renal failure (odds ratio 3.81, 95% confidence interval 2.28 to 6.37), pneumonia (odds ratio 2.01, 1.61 to 2.49), postoperative bleeding (odds ratio 1.35, 1.09 to 1.68) and septicemia (odds ratio 2.43, 1.85 to 3.21) without significant differences in overall mortality. Disability severity was positively correlated with postoperative septicemia risk. Medical service use was also significantly higher in surgical patients with intellectual disability.
  
  
  CONCLUSIONS
  Intellectual disability significantly increases the risk of overall major complications after major surgery. Our findings show a need for integrated and revised protocols for postoperative management to improve care for intellectually disabled surgical patients.
authors: Department of Anesthesiology, Taipei Medical University Hospital, Taipei, Taiwan.
authors: Jui-An
authors: JA
authors: Lin
authors: Chien-Chang
authors: CC
authors: Liao
authors: Chuen-Chau
authors: CC
authors: Chang
authors: Hang
authors: H
authors: Chang
authors: Ta-Liang
authors: TL
authors: Chen
mesh_terms: D016022:Case-Control Studies; D015897:Comorbidity; D017052:Hospital Mortality; D006801:Humans; D008607:Intellectual Disability / Q000150:complications*; D019989:Persons with Intellectual Disabilities; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality; D012306:Risk; D013624:Taiwan / Q000453:epidemiology