Adversepostoperative outcomes in elderly patients with preoperative cognitiveimpairment: A prospective cohort study
Asthe population ages, approximately one-third of elective surgical proceduresare performed on elderly patients . These patients represent a high-riskgroup of adults which are associated with increased adverse outcomes includingincreased postoperative complications and mortality . Preoperative riskassessment is important to predict the postoperative outcomes, especially forthe elderly [3,4]. Many organs such as cardiac, pulmonary, renal and hepatichave been evaluated routinely as a part of preoperative risk assessment, yetthe role of preoperative brain function assessment remains less well studied.
Recently,preoperative brain function mostly reflected by cognitive status is receivingincreasingly attention. In a prospective observational study, patients withmoderate to severe preoperative cognitive impairment are associated with higherincidence of becoming non-walker, reoperation, and 1-year mortality anddecreased quality of life after femoral neck fracture . Another study hasshowed that patients with a MiniCog score ≤2 (cognitive impairment) before surgery were more likely to developpostoperative delirium and had a longer hospital length of stay in elderly patientsscheduled for total knee or hip arthroplasty (TKA or THA) . However, thesestudies only focused on short-term outcomes. Therefore, we designed this studyto explore the association between preoperative cognitive impairment andlong-term clinical outcomes in older patients undergoing TKA or THA.
Thepresent study was approved by the Institutional Ethics Committee of JinlingHospital of Nanjing University, Nanjing (Clinical trials. gov; registrationnumber NCT03143595). Inclusion criteria include patients aged ≥65years undergoing elective TKA or THA in Jinling Hospital between April 12, 2013and August 8, 2013. Exclusion criteria include those unwilling to participate,the presence of serious hearing or vision loss, and concurrent enrollment in anotherclinical study. In our study, 217 patients were enrolled and written informed consentwas obtained from all participants or representative prior testing. Patientswere divided into impaired cognition group (n = 61) and normal cognition group(n = 156) according to baseline cognition assessed by the mini-mental stateexamination 24 h before surgery. Clinical outcomes included length of stay,postoperative complications, and 5-year survival rate.
Weobserved that the length of stay in the impaired cognition group is prolongedcompared with the normal cognition group. In addition, patients in the impairedcognition group show higher incidence of postoperative delirium than that inthe normal cognition group. The 5-year survival rate in the impaired cognitiongroup is significantly lower than their normal counterparts (Table 1).
Ourstudy confirms previous findings that preoperative cognitive impairment isassociated with adverse outcomes in elderly patients undergoing elective THA or THA（原文如此，小麻哥认为应该是TKA or THA）. Thus, routine screening for cognitive performance may be necessary forsurgical patients especially for the elderly.
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