Lower postsurgical mortality for individuals with dementia with better‐educated hospital workforce

• Autores: Elizabeth M. White, Jessica G. Smith, Rebecca L. Trotta, Matthew D. McHugh
• Localización: Journal of the American Geriatrics Society, ISSN 0002-8614, Vol. 66, Nº. 6, 2018, págs. 1137-1143
• Idioma: inglés
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• Resumen

  • Objectives To investigate whether care in a hospital with more nurses holding at least a Bachelor of Science in Nursing (BSN) degree is associated with lower mortality for individuals with Alzheimer's disease and related dementias (ADRD) undergoing surgery ADRD.

    Design Cross‐sectional data from 2006–07 Medicare claims were linked with the Multi‐State Nursing Care and Patient Safety Survey of nurses in 4 states.

    Setting Adult, nonfederal, acute care hospitals in California, Florida, New Jersey, and Pennsylvania (N=531).

    Participants Medicare beneficiaries aged 65 and older with and without ADRD undergoing general, orthopedic, or vascular surgery (N=353,333; ADRD, n=46,163; no ADRD, n=307,170).

    Measurements Thirty‐day mortality and failure to rescue (death after a complication).

    Results Controlling for hospital, procedure, and individual characteristics, each 10% increase in the proportion of BSN nurses was associated with 4% lower odds of death (odds ratio (OR)=0.96, 95% confidence interval (CI)=0.93–0.98) for individuals without ADRD, but 10% lower odds of death (OR=0.90, 95% CI=0.87–0.94) for those with ADRD. Each 10% increase in the proportion of nurses holding a BSN degree or higher was associated with 5% lower odds of failure to rescue (OR=0.95, 95% CI=0.92–0.98) for individuals without ADRD but 10% lower odds of failure to rescue (OR=0.90, 95% CI=0.87–0.94) for those with ADRD.

    Conclusion Individuals undergoing surgery who have coexisting ADRD are more likely to die within 30 days of admission and die after a complication than those without ADRD. Having more BSN nurses in the hospital improves the odds of good outcomes for all individuals and has a much greater effect in individuals with ADRD.