Frailty with dementia among elderly raises risk of death after major surgery: JAMA

A recent study by Thomas Gill found that after major non-elective surgery, mortality had a 3-fold increase in frail older individuals with probable dementia. This study published in the Journal of American Medical Association shows the potential prognostic efficacy of geriatric conditions after surgery. 

This prospective cohort study with 1-year follow-up (from 2011 to 2018) was carried out in the United States. This study included 5590 Medicare beneficiaries from the National Health and Aging Trends Study (NHATS) of 65 years or more. 

The highlights of this study were:

• Out of the 1193 major surgeries (from 992 community-living participants) that happened from from 2011 to 2017, the mean (SD) age was 79.2 (7.1) years.
• The study had 665 women (55.7%), and 30 Hispanic (2.5%), 198 non-Hispanic Black (16.6%), and 915 non-Hispanic White (76.7%).
• Over the follow-up period, there were 206 deaths representing 872 096 survey-weighted deaths and 13.4% (95% CI, 10.9%-15.9%) mortality.
• The Mortality rates were 7.4% for elective surgeries and 22.3% for non-elective surgeries.
• In the geriatric subgroups, 1-year mortality was 6.0% in non-frail persons, 27.8% in those who were frail, 11.6% in people without dementia, and 32.7% in those with probable dementia.
• The adjusted hazard ratios for 1-year mortality were 4.41 in frail persons with a reduction in restricted mean survival time of 48.8 days and 2.18 r those with probable dementia with a reduction in restricted mean survival time of 44.9 days.

In conclusion, this study brought out the fact that, more than 1 out of 4 of frail, community-living older US adult and nearly 1 out of 3 who had probable dementia died in the year after a major surgery.

For further reading:

Gill, T. M., Vander Wyk, B., Leo-Summers, L., Murphy, T. E., & Becher, R. D. (2022). Population-Based Estimates of 1-Year Mortality After Major Surgery Among Community-Living Older US Adults. In JAMA Surgery (p. e225155). American Medical Association (AMA). https://doi.org/10.1001/jamasurg.2022.5155