Login to Access Video or Poster Abstract: MP96-03
Sources of Funding: NIA R03AG050872-01; NIDDK K12DK83021-07

Introduction

Surgery is commonly performed in frail older individuals seeking care for urologic conditions. While it is known that major urologic surgery is associated with increased morbidity and mortality, outcomes of minor urologic surgery among frail older adults remain unknown. The objective of this study is to explore the long-term functional outcomes associated with minor urologic surgery among nursing home residents.

Methods

Using inpatient Medicare claims and the Minimum Data Set (MDS) for Nursing Homes, we identified all nursing home residents who underwent the following minor urologic procedures between 2004 and 2012: cystoscopy, cystoscopy with bladder biopsy, transurethral resection of bladder tumor (TURBT), prostate biopsy, transurethral resection of the prostate (TURP), removal of ureteral obstruction, and suprapubic tube placement. We examined changes in activities of daily living (ADL) and mortality up to 12 months after surgery and examined factors associated with ADL decline and mortality over this time period.

Results

We identified 37,671 individuals residing in nursing homes who underwent minor urologic surgery during the study period. Mean age was 81.5 (±7.4) years, 63.7% were male and 78.2% of procedures were elective. At baseline, 29.2% experienced declines in ADLs in the past 6 months and 60.3% had cognitive impairment. Following surgery, 11.5% and 48.7% of individuals were dead within 1 and 12 months, respectively, while ADLs declined steadily over this time period (Figure). Poorer baseline ADL status and ADL decline at baseline were both predictors for death or ADL decline in the 12 months following surgery [adjusted HR 1.40 (95% CI 1.28-1.53) for worst quartile of ADL status compared to best quartile] and [adjusted HR 1.38 (95% CI 1.29-1.47)], respectively.

Conclusions

Patients undergoing relatively minor urologic surgery experience detriments in function and high rates of mortality in the year following surgery. This information is important to weigh the risks and benefits of any type of surgery, no matter how small, in this vulnerable population.

Funding

NIA R03AG050872-01; NIDDK K12DK83021-07