The effect of cognitive dysfunction on mid- and long-term mortality after vascular surgery

Abstract

Background In recent decades, previous studies have noted the importance of frailty, which is a frequently used term in perioperative risk evaluations. Psychological and socioeconomical domains were investigated as part of frailty syndrome. The aim of this study was to assess the importance of these factors in mortality after vascular surgery. Methods In our prospective, observational study (ClinicalTrials.gov Identifier: NCT02224222), we examined 164 patients who underwent elective vascular surgery between 2014 and 2017. At the outpatient anaesthesiology clinic, patients completed a questionnaire about cognitive functions, depression and anxiety, social support and self-reported quality of life were assessed using a comprehensive frailty index, in addition to medical variables. Propensity score matching was performed to analyse the difference between patients and controls in a nationwide population cohort. The primary outcome was 4 year mortality. The Kaplan-Meier method and Cox regression analysis were used for statistical analyses. Results The patients’ mean age was 67.05 years (SD: 9.49 years). Mini-Mental State Examination scores of less than 27 points were recorded for 41 patients. Overall mortality rates were 22.4 and 47.6% in the control and cognitive impairment groups, respectively (p = 0.013). In the univariate Cox regression analysis, cognitive impairment measured using age- and education-adjusted MMSE scores increased the risk of mortality (AHR: 2.842, 95% CI: 1.389-5.815, p = 0.004). Conclusion Even mild cognitive dysfunction measured preoperatively using the MMSE represents a potentially important risk factor for mortality after vascular surgery.

Preoperative nutritional state is associated with mid- and long-term mortality after cardiac surgery

“…Patients were asked to complete the following questionnaires regarding psychosocial factors: the Spielberger State-Trait Anxiety Inventory (STAI-S, STAI-T), the Beck Depression Inventory (BDI), the Devins Illness Intrusiveness Rating Scale, the Geriatric Depression Scale, the Mini Mental State Examination (MMSE), the Somatic Symptom Severity Scale, the Caldwell Social Support Dimension Scale (CSSDS), and specific parts of the Hungarostudy (HS) survey [a representative national study from 2013, used as a control group, measuring biopsychosocial background, diseases and health-related quality of life (HRQ)]. The details of these questionnaires have been previously described (24).…”

Association between outpatient cardiac rehabilitation and all-cause mortality after cardiovascular surgery: A propensity score-matched analysis

“…Moreover, CR was associated with reduced all-cause mortality, even after adjusting for physical and cognitive functions and nutritional status. In this study's entire cohort, the non-CR group had significantly lower Short Physical Performance Battery, higher prevalence of Mini-Mental State Examination score of ≤27 points, 18 , 19 and lower Geriatric Nutritional Risk Index than the CR group, indicating that these were important confounding factors.…”

“…Furthermore, preoperative cognitive dysfunction is a known poor prognostic factor for vascular surgery. 18 Previous meta-analyses have demonstrated the effects of physical activity and resistance training on reducing cognitive decline, 25 , 26 and outpatient CR may effectively improve cognitive function. In this study, most participants undergoing CR attended at least 1 session weekly for 3 months, which was considered a sufficient frequency to obtain the above effects.…”

Is there evidence behind pre- or perioperative cognitive training in gynaecological patients on the prevention of perioperative cognitive dysfunction? A review

“…Other disciplines have published research on perioperative neurocognitive dysfunction [ 3 , 4 ]⁠, investigating biomarkers, anaesthetic techniques and post-surgical training [ 5 ]⁠. There are several aspects of cognitive function that might influence and could possibly be improved by the patients themselves.…”