Shawna Amini1,2,3, Samuel Crowley1, Loren Hizel1, Franchesca Arias1,3, David J Libon4,5,6, Patrick Tighe2,3, Chris Giordano2, Cynthia W Garvan2, F Kayser Enneking2, Catherine C Price1,2,3. 1. From the Department of Clinical and Health Psychology, University of Florida College of Public Health and Health Professions, Gainesville, Florida. 2. Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida. 3. Perioperative Cognitive Anesthesia Network, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, Florida. 4. Departments of Geriatrics. 5. Gerontology. 6. Psychology, Rowan University, School of Osteopathic Medicine, New Jersey Institute for Successful Aging, Stratford, New Jersey.
Abstract
BACKGROUND: Advanced age, frailty, low education level, and impaired cognition are generally reported to be associated with postoperative cognitive complications. To translate research findings into hospital-wide preoperative assessment clinical practice, we examined the feasibility of implementing a preoperative frailty and cognitive assessment for all older adults electing surgical procedures in a tertiary medical center. We examined associations among age, education, frailty, and comorbidity with the clock and 3-word memory scores, estimated the prevalence of mild to major cognitive impairment in the presurgical sample, and examined factors related to hospital length of stay. METHODS: Medical staff screened adults ≥65 years of age for frailty, general cognition (via the clock-drawing test command and copy, 3-word memory test), and obtained years of education. Feasibility was studied in 2 phases: (1) a pilot phase involving 4 advanced nurse practitioners and (2) a 2-month implementation phase involving all preoperative staff. We tracked sources of missing data, investigated associations of study variables with measures of cognition, and used 2 approaches to estimate the likelihood of dementia in our sample (ie, using extant data and logistic regression modeling and using Mini-Cog cut scores). We explored which protocol variables related to hospital length of stay. RESULTS: The final implementation phase sample included 678 patients. Clock and 3-word memory scores were significantly associated with age, frailty, and education. Education, clock scores, and 3-word scores were not significantly different by surgery type. Likelihood of preoperative cognitive impairment was approximately 20%, with no difference by surgery type. Length of stay was significantly associated with preoperative comorbidity and performance on the clock copy condition. CONCLUSIONS: Frailty and cognitive screening protocols are feasible and provide information for perioperative care planning. Challenges to clinical adaptation include staff training, missing data, and additional administration time. These challenges appear minimal relative to the benefits of identifying frailty and cognitive impairment in a group at risk for negative postoperative cognitive outcome.
BACKGROUND: Advanced age, frailty, low education level, and impaired cognition are generally reported to be associated with postoperative cognitive complications. To translate research findings into hospital-wide preoperative assessment clinical practice, we examined the feasibility of implementing a preoperative frailty and cognitive assessment for all older adults electing surgical procedures in a tertiary medical center. We examined associations among age, education, frailty, and comorbidity with the clock and 3-word memory scores, estimated the prevalence of mild to major cognitive impairment in the presurgical sample, and examined factors related to hospital length of stay. METHODS: Medical staff screened adults ≥65 years of age for frailty, general cognition (via the clock-drawing test command and copy, 3-word memory test), and obtained years of education. Feasibility was studied in 2 phases: (1) a pilot phase involving 4 advanced nurse practitioners and (2) a 2-month implementation phase involving all preoperative staff. We tracked sources of missing data, investigated associations of study variables with measures of cognition, and used 2 approaches to estimate the likelihood of dementia in our sample (ie, using extant data and logistic regression modeling and using Mini-Cog cut scores). We explored which protocol variables related to hospital length of stay. RESULTS: The final implementation phase sample included 678 patients. Clock and 3-word memory scores were significantly associated with age, frailty, and education. Education, clock scores, and 3-word scores were not significantly different by surgery type. Likelihood of preoperative cognitive impairment was approximately 20%, with no difference by surgery type. Length of stay was significantly associated with preoperative comorbidity and performance on the clock copy condition. CONCLUSIONS: Frailty and cognitive screening protocols are feasible and provide information for perioperative care planning. Challenges to clinical adaptation include staff training, missing data, and additional administration time. These challenges appear minimal relative to the benefits of identifying frailty and cognitive impairment in a group at risk for negative postoperative cognitive outcome.
Authors: M A Hlatky; R E Boineau; M B Higginbotham; K L Lee; D B Mark; R M Califf; F R Cobb; D B Pryor Journal: Am J Cardiol Date: 1989-09-15 Impact factor: 2.778
Authors: Julia B Sherman; Abhirup Chatterjee; Richard D Urman; Deborah J Culley; Gregory J Crosby; Zara Cooper; Houman Javedan; David L Hepner; Angela M Bader Journal: A A Pract Date: 2019-02-15
Authors: F Kayser Enneking; Nila S Radhakrishnan; Kent Berg; Saharsh Patel; Judith M Wishin; Terrie Vasilopoulos Journal: Anesth Analg Date: 2017-06 Impact factor: 5.108
Authors: J T Moller; P Cluitmans; L S Rasmussen; P Houx; H Rasmussen; J Canet; P Rabbitt; J Jolles; K Larsen; C D Hanning; O Langeron; T Johnson; P M Lauven; P A Kristensen; A Biedler; H van Beem; O Fraidakis; J H Silverstein; J E Beneken; J S Gravenstein Journal: Lancet Date: 1998-03-21 Impact factor: 79.321
Authors: Terri G Monk; B Craig Weldon; Cyndi W Garvan; Duane E Dede; Maria T van der Aa; Kenneth M Heilman; Joachim S Gravenstein Journal: Anesthesiology Date: 2008-01 Impact factor: 7.892
Authors: Catherine C Price; Jared J Tanner; Ilona Schmalfuss; Cynthia Wilson Garvan; Peter Gearen; David Dickey; Kenneth Heilman; David L McDonagh; David J Libon; Christiana Leonard; Dawn Bowers; Terri G Monk Journal: Anesthesiology Date: 2014-03 Impact factor: 7.892
Authors: Terrie B Ginsberg; Leonard Powell; Arif Patel; Sheina Emrani; Anita Chopra; Thomas Cavalieri; David J Libon Journal: J Am Osteopath Assoc Date: 2017-11-01
Authors: Franchesca Arias; Michael Riverso; Shellie-Anne Levy; Rebecca Armstrong; David S Estores; Patrick Tighe; Catherine C Price Journal: Anesth Analg Date: 2019-09 Impact factor: 5.108
Authors: Franchesca Arias; Margaret Wiggins; Richard D Urman; Rebecca Armstrong; Kurt Pfeifer; Angela M Bader; David J Libon; Anita Chopra; Catherine C Price Journal: Perioper Care Oper Room Manag Date: 2020-01-25
Authors: Elizabeth Mahanna-Gabrielli; Kathy Zhang; Frederick E Sieber; Hung Mo Lin; Xiaoyu Liu; Margaret Sewell; Stacie G Deiner; Kenneth S Boockvar Journal: Anesth Analg Date: 2020-06 Impact factor: 5.108
Authors: Margaret Wiggins; Franchesca Arias; Richard D Urman; Deborah C Richman; Bobbie Jean Sweitzer; Angela F Edwards; Melissa J Armstrong; Anita Chopra; David J Libon; Catherine Price Journal: Perioper Care Oper Room Manag Date: 2020-02-05
Authors: Nila S Radhakrishnan; Mariam Mufti; Daniel Ortiz; Suzanne T Maye; Jennifer Melara; Duke Lim; Eric I Rosenberg; Catherine C Price Journal: J Alzheimers Dis Date: 2021 Impact factor: 4.472
Authors: Anis Davoudi; Catherine Dion; Shawna Amini; David J Libon; Patrick J Tighe; Catherine C Price; Parisa Rashidi Journal: Annu Int Conf IEEE Eng Med Biol Soc Date: 2020-07
Authors: Stephen H Gregory; Christopher R King; Arbi Ben Abdallah; Alex Kronzer; Troy S Wildes Journal: Br J Anaesth Date: 2020-09-14 Impact factor: 9.166
Authors: Margaret Ellenora Wiggins; Catherine Dion; Erin Formanski; Anis Davoudi; Shawna Amini; Kenneth M Heilman; Dana Penney; Randall Davis; Cynthia W Garvan; George J Arnaoutakis; Patrick Tighe; David J Libon; Catherine C Price Journal: Explor Med Date: 2021-04-30