High-Risk Surgery in Older People with Dementia

Making decisions about major surgery for older patients with dementia often is challenging: Rates of postoperative morbidity and mortality might be higher than for patients without dementia, and the patients' decision-making capacity is limited.

In a retrospective study, researchers examined outcomes among nearly 6800 U.S. Medicare patients — 8% of whom had dementia — who underwent high-risk inpatient surgical procedures. Most surgeries (71%) were elective. Patients with dementia, compared with those without it, had similar in-hospital mortality (≈4%) but higher frequencies of inpatient complications (59% vs. 42%) and 90-day mortality (16% vs. 7%). In analyses adjusted for numerous clinical and demographic characteristics — which differed su…