In the ever mounting pile of problems facing nursing home patients, we can now add another-- nursing home patients are more likely to die following gastrointestinal (GI) operations than their peers living independently.  A study compared the mortality rates for nursing home patients who underwent six types of GI operations including: bleeding GDU's, benign colon disease, colon cancer, cholecystitis and appendicitis.

After evaluating data from 30,721 nursing home patients and 1.18 million Medicare beneficiaries, the studies authors determined that nursing home patients are more than three times more likely to die following the surgical procedures than those living in the community.

The dramatic differences in the surgical outcomes are believed to be the result of a variety of factors that the study was unable to assess including poor conditioning and malnourishment.  

Despite the obviously disappointing data, surgeons are still convinced that GI surgery is necessary for some nursing home patients as that many of these conditions have almost certain mortality when left untreated. 

Now that the medical community knows that this problem exists, they must work to develop a plan to minimize some of these health known problems.  "If we can tease these things out, that's when we can try to design interventions that would optimize outcomes in terms of preparing these patients for surgery and developing pathways and interventions postoperatively," said senior author Emily Finlayson, MD, MS, an assistant professor of surgery at the University of California, San Francisco.

Though I would never hold myself out as an expert post-surgical care, my experience has been that orthopedic injuries such as hip fractures and limb fractures that require surgery are particularly devastating for nursing home patients.  Sadly, I see many of these people deteriorate physically and emotionally after this trauma.  Perhaps this research would be useful for orthopedic patients as well?

Resource:

Nursing Home Patients Suffer Higher Post-op Mortality Rates, General Surgery News, March, 2010