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Alzheimer's Dementia After Exposure to Anesthesia and Surgery in the Elderly: A Matched Natural Experiment Using Appendicitis.
Silber, Jeffrey H; Rosenbaum, Paul R; Reiter, Joseph G; Hill, Alexander S; Jain, Siddharth; Wolk, David A; Small, Dylan; Hashemi, Sean; Niknam, Bijan A; Neuman, Mark D; Fleisher, Lee A; Eckenhoff, Roderic.
Afiliação
  • Silber JH; Center for Outcomes Research, Children's Hospital of Philadelphia, Philadelphia, PA.
  • Rosenbaum PR; The Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA.
  • Reiter JG; Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
  • Hill AS; The Departments of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
  • Jain S; Department of Health Care Management, The Wharton School, University of Pennsylvania, Philadelphia, PA.
  • Wolk DA; The Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA.
  • Small D; Department of Statistics, The Wharton School, University of Pennsylvania, Philadelphia, PA.
  • Hashemi S; Center for Outcomes Research, Children's Hospital of Philadelphia, Philadelphia, PA.
  • Niknam BA; Center for Outcomes Research, Children's Hospital of Philadelphia, Philadelphia, PA.
  • Neuman MD; Center for Outcomes Research, Children's Hospital of Philadelphia, Philadelphia, PA.
  • Fleisher LA; The Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA.
  • Eckenhoff R; Department of Neurology, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
Ann Surg ; 276(5): e377-e385, 2022 11 01.
Article em En | MEDLINE | ID: mdl-33214467
OBJECTIVE: The aim of this study was to determine whether surgery and anesthesia in the elderly may promote Alzheimer disease and related dementias (ADRD). BACKGROUND: There is a substantial conflicting literature concerning the hypothesis that surgery and anesthesia promotes ADRD. Much of the literature is confounded by indications for surgery or has small sample size. This study examines elderly patients with appendicitis, a common condition that strikes mostly at random after controlling for some known associations. METHODS: A matched natural experiment of patients undergoing appendectomy for appendicitis versus control patients without appendicitis using Medicare data from 2002 to 2017, examining 54,996 patients without previous diagnoses of ADRD, cognitive impairment, or neurological degeneration, who developed appendicitis between ages 68 through 77 years and underwent an appendectomy (the ''Appendectomy'' treated group), matching them 5:1 to 274,980 controls, examining the subsequent hazard for developing ADRD. RESULTS: The hazard ratio (HR) for developing ADRD or death was lower in the Appendectomy group than controls: HR = 0.96 [95% confidence interval (CI) 0.94-0.98], P < 0.0001, (28.2% in Appendectomy vs 29.1% in controls, at 7.5 years). The HR for death was 0.97 (95% CI 0.95-0.99), P = 0.002, (22.7% vs 23.1% at 7.5 years). The HR for developing ADRD alone was 0.89 (95% CI 0.86-0.92), P < 0.0001, (7.6% in Appendectomy vs 8.6% in controls, at 7.5 years). No subgroup analyses found significantly elevated rates of ADRD in the Appendectomy group. CONCLUSION: In this natural experiment involving 329,976 elderly patients, exposure to appendectomy surgery and anesthesia did not increase the subsequent rate of ADRD.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Apendicite / Doença de Alzheimer / Disfunção Cognitiva / Anestesia Tipo de estudo: Diagnostic_studies Limite: Aged / Humans País/Região como assunto: America do norte Idioma: En Revista: Ann Surg Ano de publicação: 2022 Tipo de documento: Article País de publicação: Estados Unidos
Texto completo
Adicionar na Minha BVS
Imprimir
XML
PubMed Links
Buscar no Google

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Apendicite / Doença de Alzheimer / Disfunção Cognitiva / Anestesia Tipo de estudo: Diagnostic_studies Limite: Aged / Humans País/Região como assunto: America do norte Idioma: En Revista: Ann Surg Ano de publicação: 2022 Tipo de documento: Article País de publicação: Estados Unidos