Hospital nursing factors associated with decreased odds of mortality in older adult medicare surgical patients with depression
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Key result
Every additional patient per nurse was associated with a 4% increase in the risk-adjusted odds of 30-day mortality among older adult surgical patients with depression (OR 1.04).
Why the study?
Little research existed examining older adult surgical patient outcomes and depression, and the potential for nursing factors to affect these outcomes.
Do better hospital nursing resources reduce 30-day mortality in older adult surgical patients with and without depression?
Population
296,561 older adult surgical patients aged 65-90 across 533 acute care general hospitals
Comparison
Hospital nursing resources and the impact of depression
Design
Retrospective cohort study
Follow-up
30 days
Authors
Discussion
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Member takes
Implication
Higher nurse workloads may raise mortality risk in depressed surgical patients; extends prior associations but remains hypothesis-generating.
Study Design
Type
Cohort (n=296,561)
Multicenter
Yes
Structured PICO
Do better hospital nursing resources reduce 30-day mortality in older adult surgical patients with and without depression?
P
Population
296,561 Medicare beneficiaries aged 65 to 90 undergoing general, orthopedic, or vascular surgery, followed for 30-day mortality.
E
Exposure
Better hospital nursing resources (higher proportion of BSN-prepared nurses, better nurse work environment, lower patient-to-nurse staffing ratios)
C
Comparator
Worse hospital nursing resources (lower proportion of BSN-prepared nurses, worse nurse work environment, higher patient-to-nurse staffing ratios)
O
Outcome
30-day all-cause mortalityhard clinical
Main Result
Odds Ratio: 1.04 (95% CI 1.01–1.09)
p-value: p=<0.05
Better hospital nursing resources, including lower patient-to-nurse ratios, are associated with decreased 30-day mortality in older adult surgical patients, with a particularly pronounced benefit for those with depression.
Limitations
- Retrospective cohort design precludes determining causality
- Data is from 2006-2007, which may not reflect current practices
- Complications leading to mortality may not have been fully captured in claims data
- Underlying factors driving the relationship between staffing and mortality are not known
- Complications leading to mortality were not captured
- Proportionally fewer patients with depression among surgical patients, who are typically a healthier population
Cite This Study
Kumar et al. (2022) conducted a cohort in Older adult surgical patients with depression (n=296,561). Higher patient-to-nurse ratio vs. Lower patient-to-nurse ratio was evaluated on 30-day all-cause mortality (OR 1.04, 95% CI 1.01-1.09, p=<0.05). Every additional patient per nurse was associated with a 4% increase in the risk-adjusted odds of 30-day mortality among older adult surgical patients with depression (OR 1.04).
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