A Two-Decade Analysis of Post-Procedural Respiratory Disorder Mortality Among Older Adults in the United States

Vollständiger Abstract

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Background: Post-procedural respiratory disorders (PPRDs), including tracheostomy complications and post-surgical pulmonary insufficiency, are serious peri-operative complications among older adults. Despite their clinical importance, national mortality trends related to PPRDs have not been comprehensively characterized. Methods: We analyzed data from the CDC WONDER Multiple Cause of Death database from 1999 to 2020, focusing on decedents aged ≥65 years with ICD-10 codes J95.0–J95.9. Age-adjusted mortality rates (AAMRs) per 100 000 were calculated using the 2000 U.S. standard population. Joinpoint regression was used to assess temporal trends and estimate average annual percent change (AAPC) with 95% confidence intervals (CIs). Results: From 1999 to 2020, there were 34 722 deaths due to PPRDs among older adults. The overall AAMR declined from 6.47 to 1.78 per 100,000, with an AAPC of −5.81% (95% CI: −6.71 to −5.14). AAMRs declined across all subgroups. By sex, AAPCs were −6.71% for males and −6.11% for females. By race/ethnicity, the steepest declines occurred among Asian or Pacific Islanders (–6.99%), followed by Black individuals (–6.59%), White individuals (–6.26%), and Hispanic individuals (–5.65%). By age, the greatest decline was observed in those ≥85 years (–6.73%), followed by those aged 65–74 (–6.51%) and 75–84 (–5.80%). Geographic differences were noted: metropolitan areas showed a steeper decline (–6.37%) compared to non-metropolitan areas (–5.81%). Conclusion: PPRD-related mortality in older U.S. adults declined substantially over the past two decades. The observed decline may reflect advances in perioperative respiratory care, anesthesia practices, and critical care delivery over time. However, persistent disparities by race, age, and geography suggest targeted interventions to reduce preventable postoperative mortality and improve equity in surgical outcomes.