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Brief Preoperative Screening for Frailty and Cognitive Impairment Predicts Delirium after Spine Surgery.
Anesthesiology. 2020 12 01; 133(6):1184-1191.A

Abstract

BACKGROUND

Frailty and cognitive impairment are associated with postoperative delirium, but are rarely assessed preoperatively. The study was designed to test the hypothesis that preoperative screening for frailty or cognitive impairment identifies patients at risk for postoperative delirium (primary outcome).

METHODS

In this prospective cohort study, the authors administered frailty and cognitive screening instruments to 229 patients greater than or equal to 70 yr old presenting for elective spine surgery. Screening for frailty (five-item FRAIL scale [measuring fatigue, resistance, ambulation, illness, and weight loss]) and cognition (Mini-Cog, Animal Verbal Fluency) were performed at the time of the preoperative evaluation. Demographic data, perioperative variables, and postoperative outcomes were gathered. Delirium was the primary outcome detected by either the Confusion Assessment Method, assessed daily from postoperative day 1 to 3 or until discharge, if patient was discharged sooner, or comprehensive chart review. Secondary outcomes were all other-cause complications, discharge not to home, and hospital length of stay.

RESULTS

The cohort was 75 [73 to 79 yr] years of age, 124 of 219 (57%) were male. Many scored positive for prefrailty (117 of 218; 54%), frailty (53 of 218; 24%), and cognitive impairment (50 to 82 of 219; 23 to 37%). Fifty-five patients (25%) developed delirium postoperatively. On multivariable analysis, frailty (scores 3 to 5 [odds ratio, 6.6; 95% CI, 1.96 to 21.9; P = 0.002]) versus robust (score 0) on the FRAIL scale, lower animal fluency scores (odds ratio, 1.08; 95% CI, 1.01 to 1.51; P = 0.036) for each point decrease in the number of animals named, and more invasive surgical procedures (odds ratio, 2.69; 95% CI, 1.31 to 5.50; P = 0.007) versus less invasive procedures were associated with postoperative delirium.

CONCLUSIONS

Screening for frailty and cognitive impairment preoperatively using the FRAIL scale and the Animal Verbal Fluency test in older elective spine surgery patients identifies those at high risk for the development of postoperative delirium.

Authors

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Pub Type(s)

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

Language

eng

PubMed ID

32898243

Citation

Susano, Maria J., et al. "Brief Preoperative Screening for Frailty and Cognitive Impairment Predicts Delirium After Spine Surgery." Anesthesiology, vol. 133, no. 6, 2020, pp. 1184-1191.
Susano MJ, Grasfield RH, Friese M, et al. Brief Preoperative Screening for Frailty and Cognitive Impairment Predicts Delirium after Spine Surgery. Anesthesiology. 2020;133(6):1184-1191.
Susano, M. J., Grasfield, R. H., Friese, M., Rosner, B., Crosby, G., Bader, A. M., Kang, J. D., Smith, T. R., Lu, Y., Groff, M. W., Chi, J. H., Grodstein, F., & Culley, D. J. (2020). Brief Preoperative Screening for Frailty and Cognitive Impairment Predicts Delirium after Spine Surgery. Anesthesiology, 133(6), 1184-1191. https://doi.org/10.1097/ALN.0000000000003523
Susano MJ, et al. Brief Preoperative Screening for Frailty and Cognitive Impairment Predicts Delirium After Spine Surgery. Anesthesiology. 2020 12 1;133(6):1184-1191. PubMed PMID: 32898243.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Brief Preoperative Screening for Frailty and Cognitive Impairment Predicts Delirium after Spine Surgery. AU - Susano,Maria J, AU - Grasfield,Rachel H, AU - Friese,Matthew, AU - Rosner,Bernard, AU - Crosby,Gregory, AU - Bader,Angela M, AU - Kang,James D, AU - Smith,Timothy R, AU - Lu,Yi, AU - Groff,Michael W, AU - Chi,John H, AU - Grodstein,Francine, AU - Culley,Deborah J, PY - 2021/12/01/pmc-release PY - 2020/9/9/pubmed PY - 2020/12/15/medline PY - 2020/9/8/entrez SP - 1184 EP - 1191 JF - Anesthesiology JO - Anesthesiology VL - 133 IS - 6 N2 - BACKGROUND: Frailty and cognitive impairment are associated with postoperative delirium, but are rarely assessed preoperatively. The study was designed to test the hypothesis that preoperative screening for frailty or cognitive impairment identifies patients at risk for postoperative delirium (primary outcome). METHODS: In this prospective cohort study, the authors administered frailty and cognitive screening instruments to 229 patients greater than or equal to 70 yr old presenting for elective spine surgery. Screening for frailty (five-item FRAIL scale [measuring fatigue, resistance, ambulation, illness, and weight loss]) and cognition (Mini-Cog, Animal Verbal Fluency) were performed at the time of the preoperative evaluation. Demographic data, perioperative variables, and postoperative outcomes were gathered. Delirium was the primary outcome detected by either the Confusion Assessment Method, assessed daily from postoperative day 1 to 3 or until discharge, if patient was discharged sooner, or comprehensive chart review. Secondary outcomes were all other-cause complications, discharge not to home, and hospital length of stay. RESULTS: The cohort was 75 [73 to 79 yr] years of age, 124 of 219 (57%) were male. Many scored positive for prefrailty (117 of 218; 54%), frailty (53 of 218; 24%), and cognitive impairment (50 to 82 of 219; 23 to 37%). Fifty-five patients (25%) developed delirium postoperatively. On multivariable analysis, frailty (scores 3 to 5 [odds ratio, 6.6; 95% CI, 1.96 to 21.9; P = 0.002]) versus robust (score 0) on the FRAIL scale, lower animal fluency scores (odds ratio, 1.08; 95% CI, 1.01 to 1.51; P = 0.036) for each point decrease in the number of animals named, and more invasive surgical procedures (odds ratio, 2.69; 95% CI, 1.31 to 5.50; P = 0.007) versus less invasive procedures were associated with postoperative delirium. CONCLUSIONS: Screening for frailty and cognitive impairment preoperatively using the FRAIL scale and the Animal Verbal Fluency test in older elective spine surgery patients identifies those at high risk for the development of postoperative delirium. SN - 1528-1175 UR - https://www.unboundmedicine.com/medline/citation/32898243/Brief_Preoperative_Screening_for_Frailty_and_Cognitive_Impairment_Predicts_Delirium_after_Spine_Surgery_ L2 - https://pubs.asahq.org/anesthesiology/article-lookup/doi/10.1097/ALN.0000000000003523 DB - PRIME DP - Unbound Medicine ER -