GENERAL SURGICAL CARE IN THE NURSING-HOME PATIENT - RESULTS OF A DEDICATED GERIATRIC SURGERY CONSULT SERVICE

BACKGROUND: Although recent interest has centered on diseases that req uire operation in the elderly, few data are available about the effect s of surgical intervention on the frail nursing home patient. STUDY DE SIGN: A longitudinal study was conducted of the nature of illnesses re quiring operation and intervention in residents of a geriatric center associated with a tertiary care medical center. A unique consult servi ce for the patients was established and all referrals were prospective ly followed up. RESULTS: The actuarial 18-month survival of patients r eferred was 35 percent. Although maintenance care (e.g., decubitus ulc er, stoma, and enteral tube care) made up a substantial number of refe rrals (32.5 percent), common surgical diseases of the abdomen, breast, and vascular system were routinely encountered (55 percent). In patie nts undergoing surgery, the 30-day mortality rate was 8.5 percent, and the complication rate 9.4 percent. Although patients undergoing major abdominal and vascular procedures had a higher complication rate (17. 6 percent) than those undergoing lesser procedures (6.3 percent, p=0.0 5), there was no difference in the 30-day mortality (9.8 compared with 6.3 percent, respectively) or 18-month actuarial survival (33 compare d with 32 percent, respectively) rates. The overall actuarial survival was adversely affected by the presence of coronary artery disease (re lative risk [RR], 3.27) and dementia (Mini-Mental State Examination sc ore less than 24; RR, 2.39), and age older than 70 years (RR, 2.03). T he overall survival was unaffected by the actual need for operation, t he magnitude of the procedure performed, gender the number of comorbid conditions, and the preoperative code (resuscitative) status. CONCLUS IONS: Although nursing home patients referred for surgical interventio n have poor survival rates, the use of surgical procedures does not ad versely affect overall survival. This supports the idea that care for this patient population is not futile, and quality of life, patient di gnity, and relief of suffering can provide a alternative to curative t herapy.