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Long-term Care

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Even seemingly mild complications after surgery may radically alter an elderly person's risk of dying

From 10 to 40 percent of elderly patients undergoing surgery will develop a postoperative complication. Even seemingly mild initial complications may profoundly alter postoperative prognosis, regardless of how severely ill patients are when admitted to the hospital. These complications often begin a cascade of other complications that end in death, according to a recent study. The researchers found that elderly patients who suffered a postoperative complication were three times as likely to die within 60 days of hospital admission as those who had no complications. Some complications were associated with even greater increases in risk of postoperative death.

Caregivers should consider the first complication as a timely signal of a changed clinical situation demanding a reevaluation of the patient's care, suggests Jeffrey H. Silber, M.D., Ph.D., of the Children's Hospital of Philadelphia and the University of Pennsylvania School of Medicine. In the study, which was supported in part by the Agency for Healthcare Research and Quality (HS09460), Dr. Silber and his colleagues analyzed Pennsylvania Medicare claims data from 1995 to 1996 on 1,362 patients. They compared postoperative death rates of those who did and did not suffer initial postoperative complications.

The odds of dying within 60 days increased 3.4-fold in patients with complications compared with those who did not have complications. A first complication of respiratory compromise was associated with a 7.2-fold increase in the odds of dying. Initial complications of pneumonia or congestive heart failure were associated with a 5-fold increase in the odds of dying compared with no complication.

See "Changes in prognosis after the first postoperative complication," by Dr. Silber, Paul R. Rosenbaum, Ph.D., Martha E. Trudeau, M.P.A., R.N., and others, in the February 2005 Medical Care 43(2), pp. 122-131.

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