Association of preoperative cognitive frailty with postoperative complications in elderly patients under general anesthesia: a prospective cohort study

Abstract

Background Cognitive frailty is defined as the coexistence of physical frailty and mild cognitive impairment, which is associated with adverse outcomes. Due to various factors such as age-related changes in the brain and the presence of comorbidities, the elderly are more susceptible to cognitive frailty. Objective To investigate the effect of preoperative cognitive frailty on postoperative complications in elderly patients. Methods This prospective observational study was conducted among 253 patients aged 60–85 years, who underwent elective orthopedic and abdominal surgery (postoperative hospital stay ≥ 3 days ) in the Second Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine from May 2023 to November 2023. Cognitive frailty was assessed using the MoCA for the cognitive status and the Fried criteria for five frailty scales. The participants were split into the following groups: group A, neither frail nor cognitive impairment; group B, only frailty ; group C, only cognitive impairment; group D, cognitive frailty. Primary outcome was the impact on postoperative complications. Secondary outcomes included mobility disability, prolonged hospital stay, re-operation and 90-day readmission. Results The median age ( interquartile range ) of participants was 69 (65–73) years, of which 40.3% were male. The prevalence of cognitive frailty was 17.8%. The incidence of postoperative complications was 18.2% in group A, 50.0% in group B, 37.4% in group C, and 75.6% in group D. The difference was significant (P < 0.001). In the multivariate analysis, cognitive frailty [odds ratio (OR), 16.84; 95% confidence interval (CI), 4.54–62.37], only frailty (OR, 7.86; 95%CI, 2.12-29. 12), only cognitive impairment (OR, 4.22; 95%CI, 1.62–11.02). Conclusions Cognitive frailty was associated with higher risks of postoperative complications in elderly patients undergoing general anesthesia. It indicates that clinicians should pay much attention to these elderly with cognitive frailty.