Preoperative cognitive dysfunction is related to adverse postoperative outcomes in the elderly.
Preoperative cognitive dysfunction is related to adverse postoperative outcomes in the elderly.
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DOI：
10.1016/j.jamcollsurg.2012.02.007
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发表时间：
2012-07
影响因子：
5.2
通讯作者：
Moss, Marc
中科院分区：
文献类型：
--
作者：
Robinson, Thomas N.;Wu, Daniel S.;Pointer, Lauren F.;Dunn, Christina L.;Moss, Marc
术前风险分层通常通过评估终末器官功能(如心脏和肺功能)来确定术后风险。对术前认知受损和预后知之甚少。这项研究的目的是评估基线认知受损对老年手术患者术后结果的影响。前瞻性地，招募了年龄在65岁及以上的受试者，这些受试者正在接受需要术后入住ICU的有计划的择期手术。术前基线认知评估采用经验证的Mini-Cog测试。认知损害被定义为≤3的迷你COG评分。由一个训练有素的研究团队使用迷惑评估方法-重症监护病房对精神错乱进行评估。不良结果使用退伍军人事务部外科质量改进计划定义。入选对象186例，平均年龄73±6岁。82名受试者(44%)有基线认知障碍。认知受损组有未调整的结果：≥-1术后并发症发生率增加(41%比24%；p=.011)，精神错乱发生率更高(78%比37%；p<；.001)，住院时间更长(15±14比9±9天；p=.008)，出院住院率更高(42%比18%；p=.001)，6个月死亡率更高(13%比5%；p=.040)。对单变量分析确定的潜在混杂因素进行校正后，Logistic回归发现认知障碍仍与一个或多个术后并发症的发生有关(优势比2.401；95%可信区间1.185，4.865；p=0.015)。Kaplan-Meier生存分析显示，认知受损组的死亡率较高(Log-Rank p=.008)。接受主要择期手术的老年人的基线认知障碍与术后不良结果有关，包括并发症、住院时间和长期死亡率的增加。提高对基线认知和手术结果的理解可能有助于老年人的手术决策。
Pre-operative risk stratification is commonly performed by assessing end organ function (such as cardiac and pulmonary) to define post-operative risk. Little is known about impaired pre-operative cognition and outcomes. The purpose of this study was to evaluate the impact of baseline impaired cognition on post-operative outcomes in geriatric surgery patients. Prospectively, subjects 65 years and older undergoing a planned elective operation requiring post-operative ICU admission were recruited. Pre-operative baseline cognition was assessed using the validated Mini-Cog test. Impaired cognition was defined as a Mini-Cog score of ≤3. Delirium was assessed using the Confusion Assessment Method-ICU by a trained research team. Adverse outcomes were defined using the Veterans Affairs Surgical Quality Improvement Program definitions. 186 subjects were included with an average age of 73±6 years. Eighty-two subjects (44%) had baseline impaired cognition. The impaired cognition group had the unadjusted outcomes: increased incidence of ≥1 post-operative complication (41% versus 24%; p=.011), higher incidence of delirium (78% versus 37%; p<.001), longer hospital stays (15±14 versus 9±9 days; p=.008), higher rate of discharge institutionalization (42% versus 18%; p=.001) and higher six-month mortality (13% versus 5%; p=.040). Adjusting for potential confounders determined by univariate analysis, logistic regression found impaired cognition was still associated to the occurrence of one or more post-operative complications (odds ratio 2.401; 95% confidence interval 1.185, 4.865; p=0.015). Kaplan-Meier survival analysis revealed higher mortality in the impaired cognition group (Log-Rank p =.008). Baseline cognitive impairment in older adults undergoing major elective operations is related to adverse post-operative outcomes including increased complications, length of stay and long-term mortality. Improved understanding of baseline cognition and surgical outcomes may aid surgical decision-making in older adults.
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影响因子：
--
作者：
Robinson, Thomas N.;Raeburn, Christopher D.;Moss, Marc
通讯作者：
Moss, Marc
影响因子：
8.8
作者：
Ely, EW;Margolin, R;Inouye, SK
通讯作者：
Inouye, SK
DOI：
10.1046/j.1532-5415.2003.51465.x
发表时间：
2003-10-01
影响因子：
6.3
作者：
Borson, S;Scanlan, JM;Ganguli, M
通讯作者：
Ganguli, M
影响因子：
3.1
作者：
Schneider, PD
通讯作者：
Schneider, PD
影响因子：
5.7
作者：
Plassman, B. L.;Langa, K. M.;Wallace, R. B.
通讯作者：
Wallace, R. B.