Poor Performance on a Preoperative Cognitive Screening Test Predicts Postoperative Complications in Older Orthopedic Surgical Patients

Abstract

Background The American College of Surgeons and the American Geriatrics Society have suggested that preoperative cognitive screening should be performed in older surgical patients. We hypothesized that unrecognized cognitive impairment in patients without a history of dementia is a risk factor for development of postoperative complications. Methods We enrolled 211 patients 65 yr of age or older without a diagnosis of dementia who were scheduled for an elective hip or knee replacement. Patients were cognitively screened preoperatively using the Mini-Cog and demographic, medical, functional, and emotional/social data were gathered using standard instruments or review of the medical record. Outcomes included discharge to place other than home (primary outcome), delirium, in-hospital medical complications, hospital length-of-stay, 30-day emergency room visits, and mortality. Data were analyzed using univariate and multivariate analyses. Results Fifty of 211 (24%) patients screened positive for probable cognitive impairment (Mini-Cog less than or equal to 2). On age-adjusted multivariate analysis, patients with a Mini-Cog score less than or equal to 2 were more likely to be discharged to a place other than home (67% vs. 34%; odds ratio = 3.88, 95% CI = 1.58 to 9.55), develop postoperative delirium (21% vs. 7%; odds ratio = 4.52, 95% CI = 1.30 to 15.68), and have a longer hospital length of stay (hazard ratio = 0.63, 95% CI = 0.42 to 0.95) compared to those with a Mini-Cog score greater than 2. Conclusions Many older elective orthopedic surgical patients have probable cognitive impairment preoperatively. Such impairment is associated with development of delirium postoperatively, a longer hospital stay, and lower likelihood of going home upon hospital discharge.

Prevalence of undiagnosed mild cognitive impairment in elderly patients undergoing thoracic surgery and its relationship with postoperative outcome: a prospective cohort study

“…Recent evidence suggests that poor preoperative cognitive function increases the risk of recent postoperative complications and the cost of care. Culley et al [16] explored that preoperative cognitive scores in elderly patients undergoing elective orthopedic surgery (Mini-Cog score ≤ 2 points) were associated with increased postoperative delirium, length of stay and increased likelihood of non-residential placement after discharge, but not associated with other complications.…”

“…The drug used in the pump was sufentanil1 ug/kg + dezocine 0.4 mg/kg (diluted to 100 ml saline, continuous dose 2 ml/h, PCA 0.5 ml, locking time 15 minutes). Based on previous clinical studies [16][17] , preoperative MCI increases the hospital length of stay, but whether it increases the incidence of postoperative complications remains unclear. Therefore, the sample size of this study may be more reasonable based on the hospital length of stay.…”

Preoperative Cognitive Impairment As a Predictor of Postoperative Outcomes in a Collaborative Care Model

“…Available data suggest that preexisting cognitive impairment predicts incident POD, which, in turn, can impair long‐term cognitive functioning . Preoperative cognitive impairment has also been linked to the incidence of other adverse outcomes, including postoperative complications, longer hospital stay, and functional decline . Nonetheless, data on the association between preoperative cognitive impairment and postoperative outcomes are limited .…”

Optimising pre‐operative assessment for older people

“…For patients with dementia there is an opportunity to involve family as advocates, and to ensure that all aspects of the proposed treatment are explored. The consent process should include discussion of the risks associated with cognitive impairment itself, the main concern being higher delirium rates but also increased peri‐operative mortality , prolonged hospital stay and greater likelihood of discharge to a place other than home . Compared with controls, patients with dementia undergoing surgery have a higher incidence of acute kidney injury, pneumonia, septicaemia, stroke and urinary tract infection .…”