Preoperative Cognitive Stratification of Older Elective Surgical Patients: A Cross-Sectional Study.

Academic Article

Abstract

  • BACKGROUND: Preexisting cognitive impairment is emerging as a predictor of poor postoperative outcomes in seniors. We hypothesized that preoperative cognitive screening can be performed in a busy preadmission evaluation center and that cognitive impairment is prevalent in elective geriatric surgical patients. METHODS: We approached 311 patients aged 65 years and older presenting for preoperative evaluation before elective surgery in a prospective, observational, single-center study. Forty-eight patients were ineligible, and 63 declined. The remaining 200 were randomly assigned to the Mini-Cog (N =100) or Clock-in-the-Box [CIB; N = 100)] test. Study staff administered the test in a quiet room, and 2 investigators scored the tests independently. Probable cognitive impairment was defined as a Mini-Cog ≤ 2 or a CIB ≤ 5. RESULTS: The age of consenting patients was 73.7 ± 6.4 (mean ± SD) years. There were no significant differences between patients randomly assigned to the Mini-Cog and CIB test in age, weight, gender, education, ASA physical status, or Charlston Index. Overall, 23% of patients met criteria for probable cognitive impairment, and prevalence was virtually identical regardless of the test used; 22% screened with the Mini-Cog and 23% screened with the CIB scored as having probable cognitive impairment (P = 1.0 by χ analysis). Both tests had good interrater reliability (Krippendroff α = 0.86 [0.72-0.93] for Mini-Cog and 1 for CIB). CONCLUSIONS: Preoperative cognitive screening is feasible in most geriatric elective surgical patients and reveals a substantial prevalence of probable cognitive impairment in this population.
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    Keywords

  • Age Factors, Aged, Boston, Chi-Square Distribution, Cognition, Cognition Disorders, Cross-Sectional Studies, Elective Surgical Procedures, Feasibility Studies, Female, Geriatric Assessment, Humans, Male, Neuropsychological Tests, Predictive Value of Tests, Preoperative Care, Prevalence, Prospective Studies, Risk Factors
  • Digital Object Identifier (doi)

    Author List

  • Culley DJ; Flaherty D; Reddy S; Fahey MC; Rudolph J; Huang CC; Liu X; Xie Z; Bader AM; Hyman BT
  • Start Page

  • 186
  • End Page

  • 192
  • Volume

  • 123
  • Issue

  • 1