Judith S L Partridge1, Jugdeep K Dhesi2, Jason D Cross2, Jessica W Lo3, Peter R Taylor4, Rachel Bell4, Finbarr C Martin5, Danielle Harari6. 1. Division of Health and Social Care Research, King's College London, London, United Kingdom; Department of Ageing and Health, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom. Electronic address: Judith.partridge@gstt.nhs.uk. 2. Department of Ageing and Health, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom. 3. Division of Health and Social Care Research, King's College London, London, United Kingdom; NIHR Biomedical Research Centre, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom. 4. Department of Vascular Surgery, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom. 5. Department of Ageing and Health, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Institute of Gerontology, King's College London, London, United Kingdom. 6. Division of Health and Social Care Research, King's College London, London, United Kingdom; Department of Ageing and Health, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.
Abstract
OBJECTIVE: The objectives of this observational cohort study were to investigate the prevalence of undiagnosed cognitive impairment in older patients presenting for vascular surgery, to examine its association with adverse postoperative outcomes, and to test the feasibility of a preoperative cognitive assessment tool. METHODS: Patients aged 60 years or older were recruited by consent on admission to the vascular surgical ward of an inner-city teaching hospital with a large tertiary referral practice for proposed elective or emergency aortic or lower limb arterial intervention. Cognition was assessed preoperatively by the Montreal Cognitive Assessment (MoCA), and a score below 24/30 indicated cognitive impairment or dementia. The mean length of time taken to complete the assessment was recorded. Baseline characteristics (medical multimorbidity, frailty, and laboratory tests), hospital length of stay (LOS), and postoperative complications were documented. RESULTS: Preoperative MoCA was completed in 114 patients with a mean age of 76.3 years (standard deviation, 7.36 years); 67.5% were men, and 55.3% of procedures were elective. The MoCA was completed in 100% of patients and was quick and acceptable to patients in this setting. Cognitive impairment or dementia was found in 68% of patients (77 of 114) and was previously unrecognized in 88.3% of patients (68 of 77). Therefore, 60.5% of patients (68 of 114) aged 60 years or older presenting for vascular surgery had previously undiagnosed cognitive impairment. MoCA <24 was univariately associated with pre-existing frailty (Edmonton Frail Scale [EFS] score ≥6.5) and longer LOS (≥12 days). In logistic regression modeling, MoCA <24 was strongly independently associated with frailty EFS score ≥6.5 (odds ratio, 12.55; P < .001). By use of the area under the receiver operating characteristic curve (AUC), MoCA <24 was predictive of longer LOS of ≥12 days (AUC, 0.621; P = .049). The strength of predictive power increased with the addition of frailty (EFS score ≥6.5) to the models (AUC, 0.695; P = .002). CONCLUSIONS: The prevalence of cognitive impairment among older patients presenting for vascular surgery is high and frequently undiagnosed before admission. It is feasible to use the MoCA to identify cognitive impairment in this high-risk surgical group preoperatively. The combined assessment of frailty and cognition is predictive of adverse postoperative outcomes and longer LOS.
OBJECTIVE: The objectives of this observational cohort study were to investigate the prevalence of undiagnosed cognitive impairment in older patients presenting for vascular surgery, to examine its association with adverse postoperative outcomes, and to test the feasibility of a preoperative cognitive assessment tool. METHODS:Patients aged 60 years or older were recruited by consent on admission to the vascular surgical ward of an inner-city teaching hospital with a large tertiary referral practice for proposed elective or emergency aortic or lower limb arterial intervention. Cognition was assessed preoperatively by the Montreal Cognitive Assessment (MoCA), and a score below 24/30 indicated cognitive impairment or dementia. The mean length of time taken to complete the assessment was recorded. Baseline characteristics (medical multimorbidity, frailty, and laboratory tests), hospital length of stay (LOS), and postoperative complications were documented. RESULTS: Preoperative MoCA was completed in 114 patients with a mean age of 76.3 years (standard deviation, 7.36 years); 67.5% were men, and 55.3% of procedures were elective. The MoCA was completed in 100% of patients and was quick and acceptable to patients in this setting. Cognitive impairment or dementia was found in 68% of patients (77 of 114) and was previously unrecognized in 88.3% of patients (68 of 77). Therefore, 60.5% of patients (68 of 114) aged 60 years or older presenting for vascular surgery had previously undiagnosed cognitive impairment. MoCA <24 was univariately associated with pre-existing frailty (Edmonton Frail Scale [EFS] score ≥6.5) and longer LOS (≥12 days). In logistic regression modeling, MoCA <24 was strongly independently associated with frailty EFS score ≥6.5 (odds ratio, 12.55; P < .001). By use of the area under the receiver operating characteristic curve (AUC), MoCA <24 was predictive of longer LOS of ≥12 days (AUC, 0.621; P = .049). The strength of predictive power increased with the addition of frailty (EFS score ≥6.5) to the models (AUC, 0.695; P = .002). CONCLUSIONS: The prevalence of cognitive impairment among older patients presenting for vascular surgery is high and frequently undiagnosed before admission. It is feasible to use the MoCA to identify cognitive impairment in this high-risk surgical group preoperatively. The combined assessment of frailty and cognition is predictive of adverse postoperative outcomes and longer LOS.
Authors: Alvin G Thomas; Jessica M Ruck; Ashton A Shaffer; Christine E Haugen; Hao Ying; Fatima Warsame; Nadia Chu; Michelle C Carlson; Alden L Gross; Silas P Norman; Dorry L Segev; Mara McAdams-DeMarco Journal: Transplantation Date: 2019-07 Impact factor: 4.939
Authors: Elizabeth L George; Rui Chen; Amber W Trickey; Benjamin S Brooke; Larry Kraiss; Matthew W Mell; Philip P Goodney; Jason Johanning; Jason Hockenberry; Shipra Arya Journal: J Vasc Surg Date: 2019-05-27 Impact factor: 4.268
Authors: Owoicho Adogwa; Aladine A Elsamadicy; Emily Lydon; Victoria D Vuong; Joseph Cheng; Isaac O Karikari; Carlos A Bagley Journal: J Spine Surg Date: 2017-09
Authors: Annie M Racine; Tamara G Fong; Yun Gou; Thomas G Travison; Douglas Tommet; Kristen Erickson; Richard N Jones; Bradford C Dickerson; Eran Metzger; Edward R Marcantonio; Eva M Schmitt; Sharon K Inouye Journal: Alzheimers Dement Date: 2017-11-27 Impact factor: 21.566
Authors: Connor T A Brenna; Beverley A Orser; Sinziana Avramescu; Andrew Fleet; Lilia Kaustov; Stephen Choi Journal: Brain Behav Date: 2021-03-04 Impact factor: 2.708