Lower Postsurgical Mortality for Individuals with Dementia with Better‐Educated Hospital Workforce.

Objectives: To investigate whether care in a hospital with more nurses holding at least a Bachelor of Science in Nursing (BSN) degree is associated with lower mortality for individuals with Alzheimer's disease and related dementias (ADRD) undergoing surgery ADRD. Design: Cross‐sectional data from 2006–07 Medicare claims were linked with the Multi‐State Nursing Care and Patient Safety Survey of nurses in 4 states. Setting: Adult, nonfederal, acute care hospitals in California, Florida, New Jersey, and Pennsylvania (N=531). Participants: Medicare beneficiaries aged 65 and older with and without ADRD undergoing general, orthopedic, or vascular surgery (N=353,333; ADRD, n=46,163; no ADRD, n=307,170). Measurements: Thirty‐day mortality and failure to rescue (death after a complication). Results: Controlling for hospital, procedure, and individual characteristics, each 10% increase in the proportion of BSN nurses was associated with 4% lower odds of death (odds ratio (OR)=0.96, 95% confidence interval (CI)=0.93–0.98) for individuals without ADRD, but 10% lower odds of death (OR=0.90, 95% CI=0.87–0.94) for those with ADRD. Each 10% increase in the proportion of nurses holding a BSN degree or higher was associated with 5% lower odds of failure to rescue (OR=0.95, 95% CI=0.92–0.98) for individuals without ADRD but 10% lower odds of failure to rescue (OR=0.90, 95% CI=0.87–0.94) for those with ADRD. Conclusion: Individuals undergoing surgery who have coexisting ADRD are more likely to die within 30 days of admission and die after a complication than those without ADRD. Having more BSN nurses in the hospital improves the odds of good outcomes for all individuals and has a much greater effect in individuals with ADRD. [ABSTRACT FROM AUTHOR]