Background

It is projected that the elderly population will continue to increase. Many will develop chronic conditions such as dementia.

Aims

Our aims are to describe the utilization of colonoscopy among patients with dementia and compare outcomes in those with and without dementia.

Methods

This population-based analysis utilized the National Inpatient Sample (NIS) during 2019. Patients with dementia over the age of 60 years receiving colonoscopy were identified utilizing ICD-10 codes. Logistic regression was used for propensity score matching between the comparison groups. A Greedy one-to-one matching algorithm was utilized along with standardized mean differences to assess balance. Mcnemar test, signed rank sum, and paired t-test were used to compare the outcomes.

Results

Initially, 50,692 patients without dementia were compared with 4323 patients with dementia. Patients with dementia were more likely to be female, older, less likely White, had lower income, and more likely to be on Medicare. In the matched comparison (4176 in each group), complication analysis showed that patients with dementia did not have higher colonoscopy-related complications. They did have higher rates of other complications including renal/AKI (p = 0.0042), pulmonary/pneumonia (p = 0.003), cerebrovascular accidents (p = 0.0063), and sepsis (< 0.0001). Patients with dementia were also less likely to have routine discharges (< 0.0001), had longer hospital stays (< 0.0001), and higher hospital costs (< 0.0001).

Conclusions

Elderly patients with dementia have similar colonoscopy-related complications as patients without dementia. However, they do have higher complications in general. The decision whether to perform colonoscopy in this patient population is multifactorial. A careful assessment of a dementia patient’s history can help with this decision.

中文翻译：

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老年痴呆症患者结肠镜检查的使用：全国匹配队列分析中的特征、并发症和费用

背景

预计老年人口将继续增加。许多人会患上痴呆症等慢性疾病。

目标

我们的目的是描述痴呆患者结肠镜检查的使用情况，并比较患有和不患有痴呆症的患者的结果。

方法

这项基于人群的分析利用了 2019 年全国住院患者样本 (NIS)。利用 ICD-10 代码对接受结肠镜检查的 60 岁以上痴呆患者进行了识别。使用逻辑回归进行比较组之间的倾向得分匹配。利用贪婪的一对一匹配算法以及标准化均值差来评估平衡。使用 Mcnemar 检验、符号秩和和配对 t 检验来比较结果。

结果

最初，对 50,692 名没有痴呆症的患者与 4323 名患有痴呆症的患者进行了比较。痴呆症患者更有可能是女性、年龄较大、白人的可能性较小、收入较低，并且更有可能享受医疗保险。在匹配比较（每组4176例）中，并发症分析显示痴呆患者并没有出现较高的结肠镜检查相关并发症。他们的其他并发症发生率确实较高，包括肾脏/AKI ( p  = 0.0042)、肺部/肺炎 ( p  = 0.003)、脑血管意外 ( p  = 0.0063) 和败血症 (< 0.0001)。痴呆症患者常规出院的可能性较小 (< 0.0001)，住院时间较长 (< 0.0001)，住院费用较高 (< 0.0001)。

结论

老年痴呆症患者与非痴呆症患者有相似的结肠镜检查相关并发症。然而，它们通常确实有较高的并发症。是否对该患者群体进行结肠镜检查的决定是多因素的。仔细评估痴呆症患者的病史有助于做出这一决定。