Cognitive impairment is associated with mortality in older adults in the emergency surgical setting: Findings from the Older Persons Surgical Outcomes Collaboration (OPSOC): A prospective cohort study.
Age Factors
Aged
Aged, 80 and over
Cognitive Dysfunction
/ diagnosis
Emergency Service, Hospital
/ statistics & numerical data
Female
Geriatric Assessment
/ methods
Hospital Mortality
Humans
Length of Stay
/ statistics & numerical data
Male
Patient Readmission
/ statistics & numerical data
Preoperative Care
/ methods
Prevalence
Prospective Studies
Risk Factors
Surgical Procedures, Operative
/ adverse effects
Treatment Outcome
United Kingdom
/ epidemiology
Journal
Surgery
ISSN: 1532-7361
Titre abrégé: Surgery
Pays: United States
ID NLM: 0417347
Informations de publication
Date de publication:
05 2019
05 2019
Historique:
received:
13
08
2018
revised:
30
09
2018
accepted:
13
10
2018
pubmed:
21
11
2018
medline:
1
1
2020
entrez:
21
11
2018
Statut:
ppublish
Résumé
Cognitive impairment is prevalent in older surgical patients; however, the condition is greatly under-recognized, and outcomes associated with it are poorly understood. This is a prospective multicenter cohort study of unselected consecutive older adults admitted to 5 emergency general surgical units across the United Kingdom participating in the Older Persons Surgical Outcomes Collaboration from 2013-2014. The effect of moderate cognitive impairment defined as ≤17, bottom quartile of Montreal Cognitive Assessment was examined using multivariate logistic regression models. Primary outcome measure was the relationship between a low Montreal Cognitive Assessment score (≤17) and mortality at 30 and 90 days. Secondary outcome measures included the association between having a low Montreal Cognitive Assessment and hospital length of stay. A total of 539 older patients admitted consecutively to 5 surgical units during the 2013 and 2014 study periods were included. The median age (interquartile range) was 76 years (70-82 years), the emergency operation rate was 13% (n = 72). The prevalence of cognitive impairment, using the traditional Montreal Cognitive Assessment cutoff score of ≤26, was 84.4% and, using the recently suggested cutoff score of ≤23, the prevalence was 61.0%. Multivariable analyses showed patients with a low Montreal Cognitive Assessment score (≤17) had a three-fold increase in 30-day mortality (adjusted odds ratio = 3.10; 95% confidence interval:1.19-8.11; P = .021) and an increased length of hospital stay (10 or more days; 1.80 [1.10-2.94; P = .02] and 14 or more days; 2.06 [1.17-3.61; P = .012]). We recommend a routine cognitive assessment in an emergency surgical setting whenever feasible to help identify patients at risk of poor outcomes.
Sections du résumé
BACKGROUND
Cognitive impairment is prevalent in older surgical patients; however, the condition is greatly under-recognized, and outcomes associated with it are poorly understood.
METHODS
This is a prospective multicenter cohort study of unselected consecutive older adults admitted to 5 emergency general surgical units across the United Kingdom participating in the Older Persons Surgical Outcomes Collaboration from 2013-2014. The effect of moderate cognitive impairment defined as ≤17, bottom quartile of Montreal Cognitive Assessment was examined using multivariate logistic regression models. Primary outcome measure was the relationship between a low Montreal Cognitive Assessment score (≤17) and mortality at 30 and 90 days. Secondary outcome measures included the association between having a low Montreal Cognitive Assessment and hospital length of stay.
RESULTS
A total of 539 older patients admitted consecutively to 5 surgical units during the 2013 and 2014 study periods were included. The median age (interquartile range) was 76 years (70-82 years), the emergency operation rate was 13% (n = 72). The prevalence of cognitive impairment, using the traditional Montreal Cognitive Assessment cutoff score of ≤26, was 84.4% and, using the recently suggested cutoff score of ≤23, the prevalence was 61.0%. Multivariable analyses showed patients with a low Montreal Cognitive Assessment score (≤17) had a three-fold increase in 30-day mortality (adjusted odds ratio = 3.10; 95% confidence interval:1.19-8.11; P = .021) and an increased length of hospital stay (10 or more days; 1.80 [1.10-2.94; P = .02] and 14 or more days; 2.06 [1.17-3.61; P = .012]).
CONCLUSION
We recommend a routine cognitive assessment in an emergency surgical setting whenever feasible to help identify patients at risk of poor outcomes.
Identifiants
pubmed: 30454842
pii: S0039-6060(18)30725-6
doi: 10.1016/j.surg.2018.10.013
pii:
doi:
Types de publication
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
978-984Informations de copyright
Copyright © 2018 Elsevier Inc. All rights reserved.