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Independent Association Between Preoperative Cognitive Status and Discharge Location After Surgery: A Strategy to Reduce Resource Use After Surgery for Deformity.
World Neurosurg. 2018 Feb; 110:e67-e72.WN

Abstract

BACKGROUND

The aim of this study is to determine whether preoperative scores on a screening measure for cognitive status (the Saint Louis University mental status examination), were associated with discharge to a location other than home in older patients undergoing surgery for deformity.

METHODS

Older patients (≥65 years) undergoing a planned elective spinal surgery for correction of adult degenerative scoliosis were enrolled in this study. Preoperative baseline cognition was assessed using the validated Saint Louis University mental status (SLUMS) test. SLUMS is 11 questions with a maximum of 30 points. Mild cognitive impairment was defined as a SLUMS score of 21-26 points, and severe cognitive impairment as a SLUMS score of 20 points or greater. Normal cognition was defined as a SLUMS score of 27 points or more. Postoperative length of stay and discharge location were recorded on all patients.

RESULTS

Eighty-two subjects were included, with mean ± standard deviation age of 73.26 ± 6.08 years; 51% of patients were discharged to a facility (skilled nursing or acute rehabilitation). After adjustment for demographic variables, comorbidities, and baseline cognitive impairment, patients with preoperative cognitive impairment were 4-fold more likely to be discharged to a facility (skilled nursing or acute rehabilitation) compared with patients with normal cognitive status (odds ratio [OR], 3.93). In addition, patients who were not ambulatory before surgery were also more likely to be discharged to a facility (OR, 7.14).

CONCLUSIONS

In geriatric patients undergoing surgery for deformity correction, cognitive screening before surgery can identify patients with impaired cognitive status who are less likely than those with normal cognitive status to return home after surgery.

Authors+Show Affiliations

Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, USA. Electronic address: owoicho.adogwa@gmail.com.Department of Neurosurgery, Duke University Medical Center, Durham, North Caroline, USA.Department of Neurosurgery, Duke University Medical Center, Durham, North Caroline, USA.Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, USA.Department of Neurosurgery, University of Texas South Western, Dallas, Texas, USA.Department of Neurosurgery, University of Cincinnati, Cincinnati, Ohio, USA.Department of Neurosurgery, Duke University Medical Center, Durham, North Caroline, USA.Department of Neurosurgery, University of Texas South Western, Dallas, Texas, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

29081391

Citation

Adogwa, Owoicho, et al. "Independent Association Between Preoperative Cognitive Status and Discharge Location After Surgery: a Strategy to Reduce Resource Use After Surgery for Deformity." World Neurosurgery, vol. 110, 2018, pp. e67-e72.
Adogwa O, Elsamadicy AA, Sergesketter A, et al. Independent Association Between Preoperative Cognitive Status and Discharge Location After Surgery: A Strategy to Reduce Resource Use After Surgery for Deformity. World Neurosurg. 2018;110:e67-e72.
Adogwa, O., Elsamadicy, A. A., Sergesketter, A., Vuong, V. D., Moreno, J., Cheng, J., Karikari, I. O., & Bagley, C. A. (2018). Independent Association Between Preoperative Cognitive Status and Discharge Location After Surgery: A Strategy to Reduce Resource Use After Surgery for Deformity. World Neurosurgery, 110, e67-e72. https://doi.org/10.1016/j.wneu.2017.10.081
Adogwa O, et al. Independent Association Between Preoperative Cognitive Status and Discharge Location After Surgery: a Strategy to Reduce Resource Use After Surgery for Deformity. World Neurosurg. 2018;110:e67-e72. PubMed PMID: 29081391.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Independent Association Between Preoperative Cognitive Status and Discharge Location After Surgery: A Strategy to Reduce Resource Use After Surgery for Deformity. AU - Adogwa,Owoicho, AU - Elsamadicy,Aladine A, AU - Sergesketter,Amanda, AU - Vuong,Victoria D, AU - Moreno,Jessica, AU - Cheng,Joseph, AU - Karikari,Isaac O, AU - Bagley,Carlos A, Y1 - 2017/11/28/ PY - 2017/08/15/received PY - 2017/10/13/revised PY - 2017/10/14/accepted PY - 2017/10/31/pubmed PY - 2018/5/15/medline PY - 2017/10/31/entrez KW - Adult degenerative scoliosis KW - Cognitive impairment KW - Continuing care facilities KW - Deformity KW - Discharge planning KW - Disposition KW - Postoperative complications KW - Preoperative planning KW - Saint Louis University mental status KW - Spine SP - e67 EP - e72 JF - World neurosurgery JO - World Neurosurg VL - 110 N2 - BACKGROUND: The aim of this study is to determine whether preoperative scores on a screening measure for cognitive status (the Saint Louis University mental status examination), were associated with discharge to a location other than home in older patients undergoing surgery for deformity. METHODS: Older patients (≥65 years) undergoing a planned elective spinal surgery for correction of adult degenerative scoliosis were enrolled in this study. Preoperative baseline cognition was assessed using the validated Saint Louis University mental status (SLUMS) test. SLUMS is 11 questions with a maximum of 30 points. Mild cognitive impairment was defined as a SLUMS score of 21-26 points, and severe cognitive impairment as a SLUMS score of 20 points or greater. Normal cognition was defined as a SLUMS score of 27 points or more. Postoperative length of stay and discharge location were recorded on all patients. RESULTS: Eighty-two subjects were included, with mean ± standard deviation age of 73.26 ± 6.08 years; 51% of patients were discharged to a facility (skilled nursing or acute rehabilitation). After adjustment for demographic variables, comorbidities, and baseline cognitive impairment, patients with preoperative cognitive impairment were 4-fold more likely to be discharged to a facility (skilled nursing or acute rehabilitation) compared with patients with normal cognitive status (odds ratio [OR], 3.93). In addition, patients who were not ambulatory before surgery were also more likely to be discharged to a facility (OR, 7.14). CONCLUSIONS: In geriatric patients undergoing surgery for deformity correction, cognitive screening before surgery can identify patients with impaired cognitive status who are less likely than those with normal cognitive status to return home after surgery. SN - 1878-8769 UR - https://www.unboundmedicine.com/medline/citation/29081391/Independent_Association_Between_Preoperative_Cognitive_Status_and_Discharge_Location_After_Surgery:_A_Strategy_to_Reduce_Resource_Use_After_Surgery_for_Deformity_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1878-8750(17)31809-0 DB - PRIME DP - Unbound Medicine ER -