Predictors of cognitive impairment in patients undergoing ileostomy for colorectal cancer: a retrospective analysis

Abstract

Background Early detection of cognitive impairment in patients undergoing ileostomy for colorectal cancer may help improve patient outcomes and quality of life. Identifying risk factors and clinically accessible factors is crucial for prevention and treatment. Objective This retrospective study aimed to identify risk factors for post-operative cognitive impairment in patients undergoing ileostomy for colorectal cancer and to explore potential factors for its prevention and treatment. Methods A total of 108 cases were selected and included in the study. Patient data including general characteristics, disease stage, complications, and chemotherapy status were collected, and sleep quality and cognitive function were assessed using questionnaires and follow-up. Patients were randomly divided into training and validation groups. A random forest model was used to rank clinical features based on their contribution to predicting the prognosis of cancer-related cognitive impairment (CRCI). Nomograms were constructed using the support vector machine–recursive feature elimination (SVM-RFE) method, and the minimal root-mean-square error (RMSE) values were compared to select the best model. Regression analysis was performed to determine independent predictors. Results Significant differences were observed in age, body mass index (BMI), alcohol consumption, frequency of physical activity, comorbidity, and cancer-related anemia (CRA) between the CRCI and non-CRCI groups. Random forest analysis revealed that age, BMI, exercise intensity, PSQI scores, and history of hypertension were the most significant predictors of outcome. Univariate logistic regression analysis of 18 variables revealed that age, alcohol consumption, exercise intensity, BMI, and comorbidity were significantly associated with the outcome of CRCI (p < 0.05). Univariate and multivariate models with P-values less than 0.1 and 0.2, respectively, showed better predictive performance for CRCI. The results of univariate analysis were plotted on a nomogram to evaluate the risk of developing CRCI after colorectal cancer surgery. The nomogram was found to have good predictive performance. Finally, regression analysis revealed that age, exercise intensity, BMI, comorbidity, and CRA were independent predictors of CRCI. Conclusions This retrospective cohort study revealed that age, exercise intensity, BMI, comorbidity, CRA, and mobility are independent predictors of cognitive impairment in patients undergoing ileostomy for colorectal cancer. Identifying these factors and potential factors may have clinical implications in predicting and managing post-operative cognitive impairment in this patient population.

The Effects of Appropriate Perioperative Exercise on Perioperative Neurocognitive Disorders: a Narrative Review

“…In another retrospective study, preoperative low physical activity was suggested in patients with gastrointestinal cancer as a predictor of POD, independent of confounding factors [ 11 ]. Similarly, preoperative low skeletal muscle mass (LSMM) [ 12 ] and exercise intensity [ 13 ] are associated with POD in older adult patients undergoing colorectal cancer (CRC) surgery. Patients with LSMM can be identified based on gender and skeletal muscle index (SMI) by assessing the cross-sectional area of skeletal muscle at the third lumbar vertebra (L3) level on computed tomography (CT) [ 14 ].…”

“… Mosk et al [ 12 ] 251 patients 76 (IQR, 73–80) Retrospective observational cohort study SMI Colorectal cancer surgery DOSS POD occurred significantly more in patients with LSMM (25%) compared with patients without LSMM (10%), p = 0.006. Xu et al [ 13 ] 122 patients 72.77 ± 5.38 Retrospective study Exercise intensity Ileostomy for colorectal cancer MoCA and FACT-Cog Exercise intensity is independent predictors of postoperative cognitive impairment. Makiguchi et al [ 16 ] 122 patients 60.3 (± 11.2) Nonrandomized, retrospective cohort study SMI Free flap repair after oral cancer resection DSM-IV Lower SMI was identified as significant independent risk factors for POD (OR 2.52; p = 0.035).…”

Predictors of postoperative delirium in patients undergoing radical prostatectomy: a prospective study

“…Predictive models have the potential to support physicians in implementing precision medicine, thus enabling the development of individualized and effective treatment strategies [6][7][8][9]. The objective of this investigation was to examine the present status and potential risk factors linked to POD in elderly individuals undergoing radical prostatectomy, as there has been little focus on them.…”