Cognitive Impairment and Overall Survival in Frail Surgical Patients

Abstract

BACKGROUND The definition of frailty, as modeled by the Fried criteria, has been limited primarily to the physical domain. The purpose of this study was to assess the additive value of cognitive function with existing frailty criteria to predict poor postoperative outcomes in a large multidisciplinary cohort of patients undergoing major operations. STUDY DESIGN A 4-level composite frailty scoring system was created via the combination of the Fried frailty score and the Emory Clock Draw Test to assess preoperative frailty and cognitive impairment, respectively. Overall survival was defined as months from date of operation to date of death or last follow-up. RESULTS This study included 330 patients undergoing major operations; mean age was 58 years and a total of 53 patient deaths occurred during 4-year follow-up. Among the robust cohort, 20 of 168 patients died (11.9%), and among those who were both physically frail and cognitively impaired, 11 of 26 patients died (42.3%). Multivariable analysis demonstrated the physically frail and cognitively impaired cohort to have a 3.92 higher risk of death (95% CI 1.66 to 9.26) compared with the cohort of robust patients (p = 0.002). Kaplan-Meier survival curves reveal an overall difference in long-term survival (log-rank p < 0.0001), driven mainly by the high risk of mortality among patients with both physical frailty and cognitive impairment. CONCLUSIONS The use of a combined frailty and cognitive assessment score has a more powerful potential to predict adult patients at higher risk of overall survival than either measurement alone. The addition of cognitive assessment to physical frailty measure can lead to improved preoperative decision making and possibly early intervention, as well as more accurate patient counseling.

SIRT3 activator honokiol ameliorates surgery/anesthesia‐induced cognitive decline in mice through anti‐oxidative stress and anti‐inflammatory in hippocampus

“…Although cognitive decline after surgery was widely emphasized by clinicians and researchers and several interventions seemed to do work, its underlying mechanisms and specific therapeutic target remained unknown and should be studies further. Considerable mechanisms are implicated in the etiology of postoperative cognitive impairment including oxidative stress and neuroinflammation, which contribute to the loss of neurons . HNK, due to its multiple biological functions, has been demonstrated effectively to ameliorate brain injury, cardiomyopathy, and suppress tumor.…”

“…HNK treatment improved the positive cells number compared with surgery group. [27][28][29][30] HNK, due to its multiple biological functions, has been demonstrated effectively to ameliorate brain injury, cardiomyopathy, and suppress tumor. In these researches, HNK owned a wealth of approaches by which it buffers inflammatory and oxidative damage, such as JAK/STAT, sirtuins, Stat3/Zeb1/E-cadherin axis, amyloidogenic pathway, and mitochondrial dynamics.…”

Brief Preoperative Screening for Frailty and Cognitive Impairment Predicts Delirium after Spine Surgery

“…4 Likewise, both conditions are common in older surgical patients and are associated with a higher risk of developing postoperative delirium, other in-hospital complications, prolonged hospital length of stay, discharge not to home, hospital readmission, and mortality. [5][6][7][8][9][10] Nonetheless, preoperative screening for frailty or cognitive impairment are not typically performed before a surgical procedure.…”

Effect of multidisciplinary prehabilitation-rehabilitation on outcomes after colorectal surgery in elderly patients

“…24,25 Nonetheless, frailty does not take cognitive aspects into account, and both frailty and cognitive impairment are predictors of postoperative survival. 26 Reduced cognitive reserve affects patient judgement of care needs. Preoperative cognitive intervention has been reported to improve postoperative cognitive function.…”