András Szabó1, Krisztina Tóth2, Ádám Nagy2, Dominika Domokos3, Nikoletta Czobor4, Csaba Eke2, Ágnes Sándor5, Béla Merkely3, Éva Susánszky6, János Gál5, Andrea Székely5. 1. Department of Anesthesiology and Intensive Therapy, Semmelweis University, 78 Üllői st., Budapest, H-1082, Hungary. andraas.szaboo@gmail.com. 2. Károly Rácz School of PhD Studies, Semmelweis University, Budapest, Hungary. 3. Heart and Vascular Center, Semmelweis University, Budapest, Hungary. 4. Department of Anesthesiology and Intensive Care, Medical Centre of Hungarian Defense Forces, Budapest, Hungary. 5. Department of Anesthesiology and Intensive Therapy, Semmelweis University, 78 Üllői st., Budapest, H-1082, Hungary. 6. Institute of Behavioural Science, Semmelweis University, Budapest, Hungary.
Abstract
BACKGROUND: In recent decades, previous studies have noted the importance of frailty, which is a frequently used term in perioperative risk evaluations. Psychological and socioeconomical domains were investigated as part of frailty syndrome. The aim of this study was to assess the importance of these factors in mortality after vascular surgery. METHODS: In our prospective, observational study (ClinicalTrials.gov Identifier: NCT02224222), we examined 164 patients who underwent elective vascular surgery between 2014 and 2017. At the outpatient anaesthesiology clinic, patients completed a questionnaire about cognitive functions, depression and anxiety, social support and self-reported quality of life were assessed using a comprehensive frailty index, in addition to medical variables. Propensity score matching was performed to analyse the difference between patients and controls in a nationwide population cohort. The primary outcome was 4 year mortality. The Kaplan-Meier method and Cox regression analysis were used for statistical analyses. RESULTS: The patients' mean age was 67.05 years (SD: 9.49 years). Mini-Mental State Examination scores of less than 27 points were recorded for 41 patients. Overall mortality rates were 22.4 and 47.6% in the control and cognitive impairment groups, respectively (p = 0.013). In the univariate Cox regression analysis, cognitive impairment measured using age- and education-adjusted MMSE scores increased the risk of mortality (AHR: 2.842, 95% CI: 1.389-5.815, p = 0.004). CONCLUSION: Even mild cognitive dysfunction measured preoperatively using the MMSE represents a potentially important risk factor for mortality after vascular surgery.
BACKGROUND: In recent decades, previous studies have noted the importance of frailty, which is a frequently used term in perioperative risk evaluations. Psychological and socioeconomical domains were investigated as part of frailty syndrome. The aim of this study was to assess the importance of these factors in mortality after vascular surgery. METHODS: In our prospective, observational study (ClinicalTrials.gov Identifier: NCT02224222), we examined 164 patients who underwent elective vascular surgery between 2014 and 2017. At the outpatient anaesthesiology clinic, patients completed a questionnaire about cognitive functions, depression and anxiety, social support and self-reported quality of life were assessed using a comprehensive frailty index, in addition to medical variables. Propensity score matching was performed to analyse the difference between patients and controls in a nationwide population cohort. The primary outcome was 4 year mortality. The Kaplan-Meier method and Cox regression analysis were used for statistical analyses. RESULTS: The patients' mean age was 67.05 years (SD: 9.49 years). Mini-Mental State Examination scores of less than 27 points were recorded for 41 patients. Overall mortality rates were 22.4 and 47.6% in the control and cognitive impairment groups, respectively (p = 0.013). In the univariate Cox regression analysis, cognitive impairment measured using age- and education-adjusted MMSE scores increased the risk of mortality (AHR: 2.842, 95% CI: 1.389-5.815, p = 0.004). CONCLUSION: Even mild cognitive dysfunction measured preoperatively using the MMSE represents a potentially important risk factor for mortality after vascular surgery.
Entities:
Keywords:
Cognitive dysfunction; Mini mental state examination; Perioperative risk factors; Psychosocial factors; Social support; Vascular surgery
Authors: Rebecca L Johnson; Matthew P Abdel; Ryan D Frank; Alanna M Chamberlain; Elizabeth B Habermann; Carlos B Mantilla Journal: J Arthroplasty Date: 2018-09-25 Impact factor: 4.757