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Preoperative Cognitive Impairment As a Predictor of Postoperative Outcomes in a Collaborative Care Model.
J Am Geriatr Soc 2018; 66(3):584-589JA

Abstract

OBJECTIVES

To compare postoperative outcomes of individuals with and without cognitive impairment enrolled in the Perioperative Optimization of Senior Health (POSH) program at Duke University, a comanagement model involving surgery, anesthesia, and geriatrics.

DESIGN

Retrospective analysis of individuals enrolled in a quality improvement program.

SETTING

Tertiary academic center.

PARTICIPANTS

Older adults undergoing surgery and referred to POSH (N = 157).

MEASUREMENTS

Cognitive impairment was defined as a score less than 25 out of 30 (adjusted for education) on the St. Louis University Mental Status (SLUMS) Examination. Median length of stay (LOS), mean number of postoperative complications, rates of postoperative delirium (POD, %), 30-day readmissions (%), and discharge to home (%) were compared using bivariate analysis.

RESULTS

Seventy percent of participants met criteria for cognitive impairment (mean SLUMS score 20.3 for those with cognitive impairment and 27.7 for those without). Participants with and without cognitive impairment did not significantly differ in demographic characteristics, number of medications (including anticholinergics and benzodiazepines), or burden of comorbidities. Participants with and without cognitive impairment had similar LOS (P = .99), cumulative number of complications (P = .70), and 30-day readmission (P = .20). POD was more common in those with cognitive impairment (31% vs 24%), but the difference was not significant (P = .34). Participants without cognitive impairment had higher rates of discharge to home (80.4% vs 65.1%, P = .05).

CONCLUSION

Older adults with and without cognitive impairment referred to the POSH program fared similarly on most postoperative outcomes. Individuals with cognitive impairment may benefit from perioperative geriatric comanagement. Questions remain regarding the validity of available measures of cognition in the preoperative period.

Authors+Show Affiliations

Division of Geriatrics, Department of Internal Medicine, Duke University Health Systems, Durham, North Carolina.Division of Geriatrics, Department of Internal Medicine, Duke University Health Systems, Durham, North Carolina.Center for Aging, Duke University Health Systems, Durham, North Carolina.Division of Geriatric Behavioral Health, Department of Psychiatry, Duke University Health Systems, Durham, North Carolina.Department of Surgery, Duke University Health Systems, Durham, North Carolina.Division of Geriatrics, Department of Internal Medicine, Duke University Health Systems, Durham, North Carolina. Center for Aging, Duke University Health Systems, Durham, North Carolina.

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

29332302

Citation

Zietlow, Kahli, et al. "Preoperative Cognitive Impairment as a Predictor of Postoperative Outcomes in a Collaborative Care Model." Journal of the American Geriatrics Society, vol. 66, no. 3, 2018, pp. 584-589.
Zietlow K, McDonald SR, Sloane R, et al. Preoperative Cognitive Impairment As a Predictor of Postoperative Outcomes in a Collaborative Care Model. J Am Geriatr Soc. 2018;66(3):584-589.
Zietlow, K., McDonald, S. R., Sloane, R., Browndyke, J., Lagoo-Deenadayalan, S., & Heflin, M. T. (2018). Preoperative Cognitive Impairment As a Predictor of Postoperative Outcomes in a Collaborative Care Model. Journal of the American Geriatrics Society, 66(3), pp. 584-589. doi:10.1111/jgs.15261.
Zietlow K, et al. Preoperative Cognitive Impairment as a Predictor of Postoperative Outcomes in a Collaborative Care Model. J Am Geriatr Soc. 2018;66(3):584-589. PubMed PMID: 29332302.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Preoperative Cognitive Impairment As a Predictor of Postoperative Outcomes in a Collaborative Care Model. AU - Zietlow,Kahli, AU - McDonald,Shelley R, AU - Sloane,Richard, AU - Browndyke,Jeffrey, AU - Lagoo-Deenadayalan,Sandhya, AU - Heflin,Mitchell T, Y1 - 2018/01/13/ PY - 2018/1/15/pubmed PY - 2019/8/31/medline PY - 2018/1/15/entrez KW - co-management KW - cognitive impairment KW - older adults KW - postoperative outcomes SP - 584 EP - 589 JF - Journal of the American Geriatrics Society JO - J Am Geriatr Soc VL - 66 IS - 3 N2 - OBJECTIVES: To compare postoperative outcomes of individuals with and without cognitive impairment enrolled in the Perioperative Optimization of Senior Health (POSH) program at Duke University, a comanagement model involving surgery, anesthesia, and geriatrics. DESIGN: Retrospective analysis of individuals enrolled in a quality improvement program. SETTING: Tertiary academic center. PARTICIPANTS: Older adults undergoing surgery and referred to POSH (N = 157). MEASUREMENTS: Cognitive impairment was defined as a score less than 25 out of 30 (adjusted for education) on the St. Louis University Mental Status (SLUMS) Examination. Median length of stay (LOS), mean number of postoperative complications, rates of postoperative delirium (POD, %), 30-day readmissions (%), and discharge to home (%) were compared using bivariate analysis. RESULTS: Seventy percent of participants met criteria for cognitive impairment (mean SLUMS score 20.3 for those with cognitive impairment and 27.7 for those without). Participants with and without cognitive impairment did not significantly differ in demographic characteristics, number of medications (including anticholinergics and benzodiazepines), or burden of comorbidities. Participants with and without cognitive impairment had similar LOS (P = .99), cumulative number of complications (P = .70), and 30-day readmission (P = .20). POD was more common in those with cognitive impairment (31% vs 24%), but the difference was not significant (P = .34). Participants without cognitive impairment had higher rates of discharge to home (80.4% vs 65.1%, P = .05). CONCLUSION: Older adults with and without cognitive impairment referred to the POSH program fared similarly on most postoperative outcomes. Individuals with cognitive impairment may benefit from perioperative geriatric comanagement. Questions remain regarding the validity of available measures of cognition in the preoperative period. SN - 1532-5415 UR - https://www.unboundmedicine.com/medline/citation/29332302/Preoperative_Cognitive_Impairment_As_a_Predictor_of_Postoperative_Outcomes_in_a_Collaborative_Care_Model_ L2 - https://doi.org/10.1111/jgs.15261 DB - PRIME DP - Unbound Medicine ER -