Neurocognitive Disorder after Appendectomy in the Elderly: A Natural Experiment

老年人阑尾切除术后的神经认知障碍：自然实验

• 批准号: 9284894
• 负责人: JEFFREY H SILBER
• 金额: $ 221.02万
• 依托单位: CHILDREN'S HOSP OF PHILADELPHIA
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-05-01 至 2022-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9284894
• 关键词: Accounting; Address; Admission activity; Age; Aging; Algorithms; Alzheimer' s Disease; Anesthesia procedures; Appendectomy; Appendicitis; Attention; Back; Case-Control Studies; Clinical assessments; Code; Cognition; Cognitive; Cohort Studies; Communities; Comorbidity; Congestive Heart Failure; Control Groups; Data; Data Set; Databases; Dementia; Diabetes Mellitus; Diagnosis; Diagnostic; Disease; Elderly; Event; Exposure to; Fee-for-Service Plans; General Population; Gold; Health; Health and Retirement Study; Home Nursing Care; Hospital Nursing; Hypertension; Impaired cognition; Incidence; Individual; Institutes; Insurance Claim Review; Life Style; Link; Long-Term Care; Medical; Medicare; Medicare claim; Modeling; Natural experiment; Nature; Neurocognitive; Neurocognitive Deficit; Neurodegenerative Disorders; Nursing Homes; Observational Study; Operative Surgical Procedures; Outcome; Patients; Pharmaceutical Preparations; Population; Procedures; Research; Research Personnel; Retrospective Studies; Risk; Risk Factors; Sampling; Secure; Sensitivity and Specificity; Shoulder; Stroke; Surveys; System; Techniques; Test Result; Testing; Time; Twin Studies; Validation; Work; base; beneficiary; cancer surgery; cohort; cost; experience; hazard; interest; lifestyle factors; mortality; neurocognitive disorder; neurocognitive test; patient home care; patient subsets; trend; virtual

ABSTRACT Concern about long-term cognitive impairment following exposure to surgery and anesthesia has persisted over the past two decades, in part because there is no conclusive evidence; large-scale studies have not definitively demonstrated a lack of association between exposures to anesthesia and surgery and subsequent occurrences of Alzheimer’s disease and related disorders (ADRD), nor have they demonstrated strong evidence suggesting there is increased risk. This proposal seeks to better explore the association between operative exposure and neurocognitive decline through a new analysis of existing Medicare data that has the potential to overcome limitations of previous studies. This study uses a new solution for accessing and analyzing Medicare claims (the Virtual Research Data Center (VRDC)), allowing researchers, in an economi- cally feasible manner, to analyze all CMS data since 1999 through a secure remote server. By (1) utilizing a natural experiment that reflects an exposure to surgery (the event of appendectomy) but is not associated with lifestyle or disease related treatments that may themselves be associated with long-term changes in cognition, and (2) through the use of multivariate matching to account for potential observable differences in cohorts, we have the ability to compare an exposed cohort of 80,000 appendectomy cases with matched controls that are closely balanced for both observable and potentially unobservable risk factors. This enables us to better conduct a large-scale study determining if there is a long-term association between operative exposure and the rate of subsequent neurocognitive decline. Aim 1 will refine claims-based definitions of diagnoses that identify neurocognitive decline through validation of Medicare claims data against neurocognitive test results collected on samples of Medicare beneficiaries by the Health and Retirement Study, the National Health and Aging Trends Study, and clinical assessment data in the Long Term Care Minimum Data Set. Aim 2 will use these definitions to conduct a multivariate matched cohort study to compare the hazard for developing neurocognitive decline in patients who experienced the random event of appendicitis leading to an appendectomy versus controls who did not undergo an appendectomy. We hypothesize that cases with appendectomy will have an elevated hazard of neurocognitive decline as compared to controls. We will identify all patients who underwent appendectomy between ages 68 to 77 and match each case to 5 controls who were the same age and very similar on risk factors for neurocognitive decline such as diabetes, stroke and hypertension, as well as an extensive list of comorbidities, at the same point in time as the case developed appendicitis, while exactly matching patients who already show diagnostic codes for neurocognitive abnormalities and also controlling for anesthesia exposure prior to the match. Outcomes that will be examined by studying the hazard ratio of exposed to control groups will include: diagnoses of neurocognitive decline, nursing home admission, neuro- cognitive testing at the nursing home, drugs that specifically indicate neurocognitive decline, and mortality. 1

抽象的 对手术和麻醉后长期认知障碍的担忧持续存在 过去二十年来，部分原因是没有确凿的证据； 明确证明麻醉和手术以及随后的暴露之间缺乏关联 阿尔茨海默病及相关疾病（ADRD）的发生，也没有表现出强烈的 有证据表明风险增加。该提案旨在更好地探讨两者之间的关联。 通过对现有医疗保险数据的新分析，发现手术暴露和神经认知能力下降 这项研究使用了一种新的解决方案来访问和克服先前研究的局限性。 分析医疗保险索赔（虚拟研究数据中心（VRDC）），允许研究人员在经济中- 通过安全远程服务器分析自 1999 年以来的所有 CMS 数据是一种可行的方式，方法是 (1) 利用 自然实验反映了手术暴露（阑尾切除术）但与 生活方式或疾病相关的治疗本身可能与认知的长期变化有关， （2）通过使用多变量匹配来解释队列中潜在的可观察差异，我们 能够将 80,000 个阑尾切除病例的暴露队列与匹配的对照进行比较 密切平衡可观察和潜在不可观察的风险因素，这使我们能够更好地做到这一点。 进行一项大规模研究，确定手术暴露与手术风险之间是否存在长期关联 目标 1 将完善基于声明的诊断定义。 通过根据收集的神经认知测试结果验证医疗保险索赔数据来发现神经认知下降 健康与退休研究、国家健康与老龄化研究中心对医疗保险受益人样本的调查 趋势研究和长期护理最低数据集中的临床评估数据将使用这些数据。 进行多变量匹配队列研究的定义，以比较发展神经认知的风险 与经历过阑尾炎随机事件并导致阑尾切除术的患者相比，其死亡率下降 未接受阑尾切除术的对照者我们追求阑尾切除术的病例将有一个。 与对照组相比，神经认知能力下降的风险更高，我们将识别所有接受过治疗的患者。 年龄在 68 至 77 岁之间的阑尾切除术，并将每个病例与 5 个年龄相同且非常相似的对照相匹配。 神经认知能力下降的危险因素如糖尿病、中风和高血压以及 在病例发展为阑尾炎的同一时间点，列出了广泛的合并症，而正是 匹配已经显示神经认知异常诊断代码的患者，并控制 比赛前麻醉暴露的结果将通过研究风险比来检查。 接触对照组的内容包括：神经认知能力下降的诊断、入住疗养院、神经- 疗养院的认知测试、专门表明神经认知能力下降的药物和死亡率。 1

项目成果

Using Medicare claims in identifying Alzheimer's disease and related dementias.

• DOI: 10.1002/alz.12199
• 发表时间: 2020-10-08
• 期刊: Alzheimer's & dementia : the journal of the Alzheimer's Association
• 作者: Jain S;Rosenbaum PR;Reiter JG;Hoffman G;Small DS;Ha J;Hill AS;Wolk DA;Gaulton T;Neuman MD;Eckenhoff RG;Fleisher LA;Silber JH
• 通讯作者: Silber JH

Risk of Parkinson's disease after anaesthesia and surgery.

麻醉和手术后患帕金森病的风险。

• DOI: 10.1016/j.bja.2021.12.046
• 发表时间: 2022
• 期刊: British journal of anaesthesia
• 影响因子: 9.8
• 作者: Jain,Siddharth;Rosenbaum,PaulR;Reiter,JosephG;Hill,AlexanderS;Wolk,DavidA;Hashemi,Sean;Fleisher,LeeA;Eckenhoff,Roderic;Silber,JeffreyH
• 通讯作者: Silber,JeffreyH