TY - JOUR
T1 - Increased hospice enrollment and decreased neurosurgical interventions without changes in mortality for older Medicare patients with moderate to severe traumatic brain injury
AU - Enumah, Samuel
AU - Lilley, Elizabeth J.
AU - Nitzschke, Stephanie
AU - Haider, Adil H.
AU - Salim, Ali
AU - Cooper, Zara
N1 - Publisher Copyright:
© 2018
PY - 2018/6
Y1 - 2018/6
N2 - Background: Hospice improves quality and value of end of life care (EOLC), and enrollment has increased for older patients dying from chronic medical conditions. It remains unknown if the same is true for older patients who die after moderate to severe traumatic brain injury (msTBI). Methods: Subjects included Medicare beneficiaries (≥65 years) who were hospitalized for msTBI from 2005 to 2011. Outcomes included intensity and quality of EOLC for decedents within 30 days of admission, and 30-day mortality for the entire cohort. Logistic regression was used to analyze the association between year of admission, mortality, and EOLC. Results: Among 50,342 older adults, 30-day mortality was 61.2%. Mortality was unchanged over the study period (aOR 0.93 [0.87–1.00], p = 0.06). Additionally, 30-day non-survivors had greater odds of hospice enrollment, lower odds of undergoing neurosurgery, but greater odds of gastrostomy. Conclusion: Between 2005 and 2011, hospice enrollment increased, but there was no change in 30-day mortality.
AB - Background: Hospice improves quality and value of end of life care (EOLC), and enrollment has increased for older patients dying from chronic medical conditions. It remains unknown if the same is true for older patients who die after moderate to severe traumatic brain injury (msTBI). Methods: Subjects included Medicare beneficiaries (≥65 years) who were hospitalized for msTBI from 2005 to 2011. Outcomes included intensity and quality of EOLC for decedents within 30 days of admission, and 30-day mortality for the entire cohort. Logistic regression was used to analyze the association between year of admission, mortality, and EOLC. Results: Among 50,342 older adults, 30-day mortality was 61.2%. Mortality was unchanged over the study period (aOR 0.93 [0.87–1.00], p = 0.06). Additionally, 30-day non-survivors had greater odds of hospice enrollment, lower odds of undergoing neurosurgery, but greater odds of gastrostomy. Conclusion: Between 2005 and 2011, hospice enrollment increased, but there was no change in 30-day mortality.
KW - End-of-life
KW - Geriatric
KW - Medicare
KW - Trauma
KW - Traumatic brain injury
UR - http://www.scopus.com/inward/record.url?scp=85043348006&partnerID=8YFLogxK
U2 - 10.1016/j.amjsurg.2018.02.028
DO - 10.1016/j.amjsurg.2018.02.028
M3 - Article
C2 - 29534816
AN - SCOPUS:85043348006
SN - 0002-9610
VL - 215
SP - 1016
EP - 1019
JO - American Journal of Surgery
JF - American Journal of Surgery
IS - 6
ER -