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 对接受手术和麻醉后长期认知障碍的担忧持续存在 在过去的二十年中，部分原因是没有结论性证据。大规模研究尚未 明确证明了对麻醉和手术的暴露之间缺乏关联以及随后的 阿尔茨海默氏病和相关疾病的发生（ADRD）也没有表现出强大 证据表明风险增加。该建议旨在更好地探索 通过对现有Medicare数据的新分析，手术暴露和神经认知能力下降 克服先前研究的局限性的潜力。这项研究使用新解决方案访问和 分析Medicare主张（虚拟研究数据中心（VRDC）），使研究人员在经济中 - 调用可行方式，以分析自1999年以来通过安全的远程服务器分析所有CMS数据。由（1）使用 自然实验反映了接受手术的暴露（阑尾切除术的事件），但与 生活方式或疾病相关的治疗方法本身可能与认知长期变化有关， （2）通过使用多元匹配来说明同类的潜在可观察到的差异，我们 有能力将80,000例阑尾切除术病例与匹配的对照组进行比较 对于可观察和可能无法观察的危险因素而言，紧密平衡。这使我们能够更好 进行大规模研究，以确定运营暴露与 随后的神经认知下降率。 AIM 1将完善基于索赔的诊断定义 通过验证Medicare主张数据针对收集的神经认知测试结果，神经认知能力下降 关于健康和退休研究的医疗保险受益人样本，国家健康与衰老 趋势研究和长期护理最低数据集中的临床评估数据。 AIM 2将使用这些 进行多元匹配的队列研究的定义，以比较发展神经认知的危害 经历了随机发生阑尾​​炎的患者的下降，导致阑尾切除术与 没有进行阑尾切除术的对照。我们假设阑尾切除术病例将有 与对照组相比，神经认知能力下降的危害升高。我们将确定所有接受的患者 68至77岁之间的阑尾切除术，每个病例与5个对照组相同，年龄相同且非常非常 神经认知下降的危险因素相似，例如糖尿病，中风和高血压，以及 与病例相同的时间点，合并症的广泛清单，同时确切 匹配已经显示出神经认知异常诊断代码的患者 比赛前的麻醉暴露。通过研究危害比率将检查的结果 暴露于对照组的将包括：神经认知能力下降，护理家庭入院，神经的诊断 在护士家中的认知测试，专门表明神经认知能力下降和死亡率的药物。 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