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Surgeries Increasingly Dangerous in Nursing Home Residents

Nursing home negligence lawyers at Pintas & Mullins point to a troubling new study published in the Annals of Surgery detailing the risk of abdominal procedures in nursing home residents. Compared to seniors of the same age undergoing the same surgical procedure, nursing home residents experienced substantially higher rates of mortality and invasive interventions.

The study compared mortality rates for four types of abdominal surgery in elderly patients, which included surgeries for: bleeding ulcers, burst appendix, infected gallbladder, and noncancerous colon diseases such as colitis or diverticulitis. These conditions were chosen because they require immediate corrective surgery, opposed to diagnoses like lung cancer that enable patients to take a longer amount of time to consider treatment options.

Researchers used nursing home surveys and national Medicare claims to track more than 70,000 nursing home residents who underwent one of those four surgeries between 1999 and 2006. They then compared these patients’ outcomes with more than one million seniors who did not reside in nursing homes but underwent the same abdominal procedure.

After an appendectomy, 12% of the nursing home residents died, compared to only 2% of other Medicare patients not in an assisted living facility. Similarly, nursing home residents undergoing gallbladder surgery died at a rate of 11%, compared to 3% of their senior counterparts.

Troublingly, mortality rates rose sharply for the other two procedures. Nearly one third of patients from nursing homes undergoing colon operations passed away, while only 13% of the other elders did. Ulcer procedures were by far the most dangerous, with a mortality rate of an astonishing 42% in institutionalized elders and 25% of the others.

Dr. Emily Finlayson, the study’s lead author, stated that, even when they matched the two groups by specific age and number of diseases, those patients living in a long-term care facility still had significantly higher mortality rates. She offered that this may be because those institutionalized patients do not have the strength and mobility to live independently, which extends to their energy and vitality, and ultimately, their physiology.

Even those patients who survived the initial surgery, however, were not complete success stories. Nursing home residents were far more likely to have to undergo invasive interventions after the procedure, meaning they needed machines to help them breathe for days afterward, feeding tubes, and/or venous catheterization.

A substantial number of elders who are hospitalized for procedures will never again function at the same physical or mental levels, even if their initial malady is successfully treated. Surgeons and hospitals consider a procedure a success if a patient leaves the hospital alive – regardless of what happens in the near future. With elders, however, the emphasis should be treating illnesses with the least-invasive methods, instead of with what is conventional for patients half their age or with twice their vitality.

The U.S. Preventive Services Task Force, upon reviewing years of research, recommended that adults over 75 years of age should not screen for colorectal cancer. It has been reported by several institutions that colonoscopies are significantly overused in the elderly, with increasingly damaging consequences. Colon cancer develops very slowly, so, to put it bluntly, most patients over the age of 80 will not live long enough to benefit from a colonoscopy, which is risky in itself.

One patient, an 80-year-old man in good health, received a colonoscopy in 2008. The next day after surgery, he woke up screaming, eventually lost 30 pounds, and had to return to the hospital two months later to have his colostomy reversed. The initial procedure had perforated his colon, forcing him to spend a week in intensive care, which is not uncommon after bowl surgeries in seniors.

Senior neglect lawyers at Pintas & Mullins urge anyone residing in a nursing home or with a loved one in such a facility to consider alternative treatments before undergoing an invasive surgery. Nursing homes that admit patients to hospitals for unnecessary surgeries are abusing their residents, and it may be indicative or larger problems of abuse and neglect.