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Association between baseline cognitive impairment and postoperative delirium in elderly patients undergoing surgery for adult spinal deformity.
J Neurosurg Spine. 2018 01; 28(1):103-108.JN

Abstract

OBJECTIVE

Postoperative delirium is common in elderly patients undergoing spine surgery and is associated with a longer and more costly hospital course, functional decline, postoperative institutionalization, and higher likelihood of death within 6 months of discharge. Preoperative cognitive impairment may be a risk factor for the development of postoperative delirium. The aim of this study was to investigate the relationship between baseline cognitive impairment and postoperative delirium in geriatric patients undergoing surgery for degenerative scoliosis.

METHODS

Elderly patients 65 years and older undergoing a planned elective spinal surgery for correction of adult degenerative scoliosis were enrolled in this study. Preoperative cognition was assessed using the validated Saint Louis University Mental Status (SLUMS) examination. SLUMS comprises 11 questions, with a maximum score of 30 points. Mild cognitive impairment was defined as a SLUMS score between 21 and 26 points, while severe cognitive impairment was defined as a SLUMS score of ≤ 20 points. Normal cognition was defined as a SLUMS score of ≥ 27 points. Delirium was assessed daily using the Confusion Assessment Method (CAM) and rated as absent or present on the basis of CAM. The incidence of delirium was compared in patients with and without baseline cognitive impairment.

RESULTS

Twenty-two patients (18%) developed delirium postoperatively. Baseline demographics, including age, sex, comorbidities, and perioperative variables, were similar in patients with and without delirium. The length of in-hospital stay (mean 5.33 days vs 5.48 days) and 30-day hospital readmission rates (12.28% vs 12%) were similar between patients with and without delirium, respectively. Patients with preoperative cognitive impairment (i.e., a lower SLUMS score) had a higher incidence of postoperative delirium. One- and 2-year patient reported outcomes scores were similar in patients with and without delirium.

CONCLUSIONS

Cognitive impairment is a risk factor for the development of postoperative delirium. Postoperative delirium may be associated with decreased preoperative cognitive reserve. Cognitive impairment assessments should be considered in the preoperative evaluations of elderly patients prior to surgery.

Authors+Show Affiliations

1Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois.2Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina.1Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois.1Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois.3Department of Neurosurgery, Yale University, New Haven, Connecticut; and.2Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina.4Department of Neurosurgery, University of Texas Southwestern, Dallas, Texas.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

29125432

Citation

Adogwa, Owoicho, et al. "Association Between Baseline Cognitive Impairment and Postoperative Delirium in Elderly Patients Undergoing Surgery for Adult Spinal Deformity." Journal of Neurosurgery. Spine, vol. 28, no. 1, 2018, pp. 103-108.
Adogwa O, Elsamadicy AA, Vuong VD, et al. Association between baseline cognitive impairment and postoperative delirium in elderly patients undergoing surgery for adult spinal deformity. J Neurosurg Spine. 2018;28(1):103-108.
Adogwa, O., Elsamadicy, A. A., Vuong, V. D., Fialkoff, J., Cheng, J., Karikari, I. O., & Bagley, C. A. (2018). Association between baseline cognitive impairment and postoperative delirium in elderly patients undergoing surgery for adult spinal deformity. Journal of Neurosurgery. Spine, 28(1), 103-108. https://doi.org/10.3171/2017.5.SPINE161244
Adogwa O, et al. Association Between Baseline Cognitive Impairment and Postoperative Delirium in Elderly Patients Undergoing Surgery for Adult Spinal Deformity. J Neurosurg Spine. 2018;28(1):103-108. PubMed PMID: 29125432.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Association between baseline cognitive impairment and postoperative delirium in elderly patients undergoing surgery for adult spinal deformity. AU - Adogwa,Owoicho, AU - Elsamadicy,Aladine A, AU - Vuong,Victoria D, AU - Fialkoff,Jared, AU - Cheng,Joseph, AU - Karikari,Isaac O, AU - Bagley,Carlos A, Y1 - 2017/11/10/ PY - 2017/11/11/pubmed PY - 2018/6/21/medline PY - 2017/11/11/entrez KW - CAM = Confusion Assessment Method KW - MMSE = Mini–Mental State Examination KW - SLUMS = Saint Louis University Mental Status KW - SNF = skilled nursing facility KW - Saint Louis Mental Status test KW - cognitive impairment KW - deformity KW - degenerative scoliosis KW - delirium KW - elderly KW - spine surgery SP - 103 EP - 108 JF - Journal of neurosurgery. Spine JO - J Neurosurg Spine VL - 28 IS - 1 N2 - OBJECTIVE Postoperative delirium is common in elderly patients undergoing spine surgery and is associated with a longer and more costly hospital course, functional decline, postoperative institutionalization, and higher likelihood of death within 6 months of discharge. Preoperative cognitive impairment may be a risk factor for the development of postoperative delirium. The aim of this study was to investigate the relationship between baseline cognitive impairment and postoperative delirium in geriatric patients undergoing surgery for degenerative scoliosis. METHODS Elderly patients 65 years and older undergoing a planned elective spinal surgery for correction of adult degenerative scoliosis were enrolled in this study. Preoperative cognition was assessed using the validated Saint Louis University Mental Status (SLUMS) examination. SLUMS comprises 11 questions, with a maximum score of 30 points. Mild cognitive impairment was defined as a SLUMS score between 21 and 26 points, while severe cognitive impairment was defined as a SLUMS score of ≤ 20 points. Normal cognition was defined as a SLUMS score of ≥ 27 points. Delirium was assessed daily using the Confusion Assessment Method (CAM) and rated as absent or present on the basis of CAM. The incidence of delirium was compared in patients with and without baseline cognitive impairment. RESULTS Twenty-two patients (18%) developed delirium postoperatively. Baseline demographics, including age, sex, comorbidities, and perioperative variables, were similar in patients with and without delirium. The length of in-hospital stay (mean 5.33 days vs 5.48 days) and 30-day hospital readmission rates (12.28% vs 12%) were similar between patients with and without delirium, respectively. Patients with preoperative cognitive impairment (i.e., a lower SLUMS score) had a higher incidence of postoperative delirium. One- and 2-year patient reported outcomes scores were similar in patients with and without delirium. CONCLUSIONS Cognitive impairment is a risk factor for the development of postoperative delirium. Postoperative delirium may be associated with decreased preoperative cognitive reserve. Cognitive impairment assessments should be considered in the preoperative evaluations of elderly patients prior to surgery. SN - 1547-5646 UR - https://www.unboundmedicine.com/medline/citation/29125432/Association_between_baseline_cognitive_impairment_and_postoperative_delirium_in_elderly_patients_undergoing_surgery_for_adult_spinal_deformity_ L2 - https://thejns.org/doi/10.3171/2017.5.SPINE161244 DB - PRIME DP - Unbound Medicine ER -