title: Postoperative adverse outcomes in surgical patients with dementia: a retrospective cohort study.
abstract: BACKGROUND
  Dementia patients often present with coexisting medical conditions and potentially face higher risk of complications during hospitalization. Because the general features of postoperative adverse outcomes among surgical patients with dementia are unknown, we conducted a nationwide, retrospective cohort study to characterize surgical complications among dementia patients compared with sex- and age-matched nondementia controls.
  
  
  METHODS
  Reimbursement claims from the Taiwan National Health Insurance Research Database were studied. A total of 18,923 surgical patients were enrolled with preoperative diagnosis of dementia for 207,693 persons aged 60 years or older who received inpatient major surgeries between 2004 and 2007. Their preoperative comorbidities were adjusted and risks for major surgical complications were analyzed.
  
  
  RESULTS
  Dementia patients who underwent surgery had a significantly higher overall postoperative complication rate, adjusted odds ratio (OR) 1.79 (95 % confidence interval [CI] 1.72-1.86), with higher medical resources use, and in-hospital expenditures. Compared with controls, dementia patients had a higher incidence of certain postoperative complications that are less likely to be identified in their initial stage, such as: acute renal failure, OR = 1.32 (1.19-1.47); pneumonia, OR = 2.18 (2.06-2.31); septicemia, OR = 1.8 (1.69-1.92); stroke, OR = 1.51 (1.43-1.6); and urinary tract infection, OR = 1.62 (1.5-1.74).
  
  
  CONCLUSIONS
  These findings have specific implications for postoperative care of dementia patients regarding complications that are difficult to diagnose in their initial stages. Acute renal failure, pneumonia, septicemia, stroke, and urinary tract infection are the top priorities for prevention, early recognition, and intervention of postoperative complications among surgical patients with dementia. Further efforts are needed to determine specific protocols for health care teams serving this population.
authors.affiliation: Department of Neurology, College of Medicine, Taipei Medical University, 250 Wuxing Street, Taipei 110, Taiwan.
authors.forename: Chaur-Jong
authors.initials: CJ
authors.lastname: Hu
authors.forename: Chien-Chang
authors.initials: CC
authors.lastname: Liao
authors.forename: Chuen-Chau
authors.initials: CC
authors.lastname: Chang
authors.forename: Chih-Hsiung
authors.initials: CH
authors.lastname: Wu
authors.forename: Ta-Liang
authors.initials: TL
authors.lastname: Chen
mesh_terms: D000368:Aged; D015331:Cohort Studies; D015897:Comorbidity; D003704:Dementia / Q000453:epidemiology*; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D013624:Taiwan / Q000453:epidemiology