The Influence of Cognitive Impairment on Postoperative Outcomes.
Journal
Annals of surgery
ISSN: 1528-1140
Titre abrégé: Ann Surg
Pays: United States
ID NLM: 0372354
Informations de publication
Date de publication:
01 Jan 2023
01 Jan 2023
Historique:
pmc-release:
01
01
2024
pubmed:
20
2
2021
medline:
3
3
2023
entrez:
19
2
2021
Statut:
ppublish
Résumé
To examine differences in rates of elective surgery, postoperative mortality, and readmission by pre-existing cognitive status among Medicare beneficiaries undergoing surgery. MCI is common among older adults, but the impact of MCI on surgical outcomes is understudied. We conducted a retrospective cohort study of individuals ≥65 who underwent surgery between 2001 and 2015 using data from the nationally-representative Health and Retirement Study linked with Medicare claims. Cognitive status was assessed by the modified telephone interview for cognitive status score and categorized as normal cognition (score: 12-27), MCI (7-11), and dementia (<7). Outcomes were 30- and 90-day postoperative mortality and readmissions. We used Cox proportional hazard models to estimate the risk of each outcome by cognition, adjusting for patient characteristics. In 6,590 patients, 69.9% had normal cognition, 20.1% had MCI, and 9.9% had dementia. Patients with MCI (79.9%) and dementia (73.6%) were less likely to undergo elective surgery than patients with normal cognition (85.9%). Patients with MCI had similar postoperative mortality and readmissions rates as patients with normal cognition. However, patients with dementia had significantly higher postoperative 90-day mortality (5.2% vs 8.4%, P = 0.002) and readmission rates (13.9% vs 17.3%, P = 0.038). Patients with self-reported MCI are less likely to undergo elective surgery but have similar postoperative outcomes compared with patients with normal cognition. Despite the variability of defining MCI, our findings suggest that MCI may not confer additional risk for older individuals undergoing surgery, and should not be a barrier for surgical care.
Sections du résumé
OBJECTIVE
OBJECTIVE
To examine differences in rates of elective surgery, postoperative mortality, and readmission by pre-existing cognitive status among Medicare beneficiaries undergoing surgery.
BACKGROUND
BACKGROUND
MCI is common among older adults, but the impact of MCI on surgical outcomes is understudied.
METHODS
METHODS
We conducted a retrospective cohort study of individuals ≥65 who underwent surgery between 2001 and 2015 using data from the nationally-representative Health and Retirement Study linked with Medicare claims. Cognitive status was assessed by the modified telephone interview for cognitive status score and categorized as normal cognition (score: 12-27), MCI (7-11), and dementia (<7). Outcomes were 30- and 90-day postoperative mortality and readmissions. We used Cox proportional hazard models to estimate the risk of each outcome by cognition, adjusting for patient characteristics.
RESULTS
RESULTS
In 6,590 patients, 69.9% had normal cognition, 20.1% had MCI, and 9.9% had dementia. Patients with MCI (79.9%) and dementia (73.6%) were less likely to undergo elective surgery than patients with normal cognition (85.9%). Patients with MCI had similar postoperative mortality and readmissions rates as patients with normal cognition. However, patients with dementia had significantly higher postoperative 90-day mortality (5.2% vs 8.4%, P = 0.002) and readmission rates (13.9% vs 17.3%, P = 0.038).
CONCLUSION
CONCLUSIONS
Patients with self-reported MCI are less likely to undergo elective surgery but have similar postoperative outcomes compared with patients with normal cognition. Despite the variability of defining MCI, our findings suggest that MCI may not confer additional risk for older individuals undergoing surgery, and should not be a barrier for surgical care.
Identifiants
pubmed: 33605584
doi: 10.1097/SLA.0000000000004799
pii: 00000658-900000000-93698
pmc: PMC8353015
mid: NIHMS1719650
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e212-e217Subventions
Organisme : NIA NIH HHS
ID : U01 AG009740
Pays : United States
Organisme : NIA NIH HHS
ID : P30 AG024824
Pays : United States
Organisme : NINDS NIH HHS
ID : R01 NS102715
Pays : United States
Organisme : NIA NIH HHS
ID : K23 AG040278
Pays : United States
Organisme : NIDA NIH HHS
ID : R01 DA042859
Pays : United States
Organisme : NIA NIH HHS
ID : R01 AG051827
Pays : United States
Informations de copyright
Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
The authors declare no conflict of interests.
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