Preoperative biochemical evaluation of the surgical patient

Ficarra, Bernard J.

doi:10.1016/0002-9610(49)90212-3

Cited by 4 publications

(3 citation statements)

References 2 publications

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“…There is intense interest in identifying predictors of adverse outcomes in this age group, as they have a high complication rate and often do poorly. 1–4 Preoperative assessment of major vital organs has been a routine part of preparation for surgery for decades 5,6 but brain function is typically not formally evaluated. 7 Yet, cognitive impairment is common in older persons, including those living independently.…”

Section: Introductionmentioning

confidence: 99%

Poor Performance on a Preoperative Cognitive Screening Test Predicts Postoperative Complications in Older Orthopedic Surgical Patients

et al. 2017

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Background The American College of Surgeons and the American Geriatrics Society have suggested that preoperative cognitive screening should be performed in older surgical patients. We hypothesized that unrecognized cognitive impairment in patients without a history of dementia is a risk factor for development of postoperative complications. Methods We enrolled 211 patients 65 yr of age or older without a diagnosis of dementia who were scheduled for an elective hip or knee replacement. Patients were cognitively screened preoperatively using the Mini-Cog and demographic, medical, functional, and emotional/social data were gathered using standard instruments or review of the medical record. Outcomes included discharge to place other than home (primary outcome), delirium, in-hospital medical complications, hospital length-of-stay, 30-day emergency room visits, and mortality. Data were analyzed using univariate and multivariate analyses. Results Fifty of 211 (24%) patients screened positive for probable cognitive impairment (Mini-Cog less than or equal to 2). On age-adjusted multivariate analysis, patients with a Mini-Cog score less than or equal to 2 were more likely to be discharged to a place other than home (67% vs. 34%; odds ratio = 3.88, 95% CI = 1.58 to 9.55), develop postoperative delirium (21% vs. 7%; odds ratio = 4.52, 95% CI = 1.30 to 15.68), and have a longer hospital length of stay (hazard ratio = 0.63, 95% CI = 0.42 to 0.95) compared to those with a Mini-Cog score greater than 2. Conclusions Many older elective orthopedic surgical patients have probable cognitive impairment preoperatively. Such impairment is associated with development of delirium postoperatively, a longer hospital stay, and lower likelihood of going home upon hospital discharge.

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Section: Introductionmentioning

confidence: 99%

Poor Performance on a Preoperative Cognitive Screening Test Predicts Postoperative Complications in Older Orthopedic Surgical Patients

et al. 2017

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“…Preoperative assessment of risk in major organ systems is routinely performed (Ficarra, 1949). However, cognition assessment has not been included in regular preoperative screening due to limited clinical testing methods (Crosby et al, 2011).…”

Section: Introductionmentioning

confidence: 99%

Prevalence of preoperative cognitive impairment among elderly thoracic surgery patients and association with postoperative delirium: a prospective observational study

Miao

et al. 2023

Front. Hum. Neurosci.

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BackgroundPreoperative cognitive impairment (PCI) may increase the incidence of postoperative delirium (POD), yet screening for cognitive impairment is rarely performed. This study hypothesized that Mini-Cog for preoperative cognitive impairment screening predicts postoperative delirium.MethodsThe prospective observational study recruited 153 elderly patients presenting for elective thoracic surgery. Cognitive function of these patients was screened using Mini-Cog preoperatively. We considered that patients with Mini-Cog scores ≤ 3 had cognitive impairment. Delirium was assessed using the Short CAM scale on postoperative days 1–5.ResultsOf the 153 participants, 54 (35.3%) were assigned to the PCI group, and 99 (64.7%) were assigned to the Normal group. Place of residence, education level, and history of hypertension were significantly different between the two groups (P < 0.05). 51 (33.3%) patients developed POD. Multifactorial analysis revealed that PCI (OR = 2.37, P = 0.028), older age (OR = 1.13, P = 0.009), ASA grade III (OR = 2.75, P = 0.012), and longer duration of anesthesia (OR = 1.01, P = 0.007) were associated with POD.ConclusionPreoperative cognitive impairment is strongly associated with POD. Mini-Cog could be recommended for screening PCI.Clinical trial registrationClinicalTrials.gov, identifier NCT05798767.

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“…Preoperative assessment of vital organ function is a routine work [1][2][3] , while brain function assessment is not carried out routinely due to limited clinical testing methods [4] . Previous epidemiological surveys showed the prevalence of cognitive impairment in the elderly population is quite high, ranged from 35% to 50% in the population aged ≥65 years have different degrees of cognitive impairment [5][6] .…”

Section: Introductionmentioning

confidence: 99%

Prevalence of undiagnosed mild cognitive impairment in elderly patients undergoing thoracic surgery and its relationship with postoperative outcome: a prospective cohort study

Tong¹,

Wu²,

Shen³

et al. 2019

Preprint

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Background The prevalence of undiagnosed mild cognitive impairment (MCI) in elderly patients scheduled for thoracic surgery and its association with adverse clinical outcomes is still unproven. Methods We enrolled 170 patients 65 year of age or older who were scheduled for thoracic surgery. 82 males and 88 females with ASA grade II-III. All the elderly patients were tested with Chinese modified version of MoCA preoperatively. According to the test results, they were divided into two groups: group N (MoCA score>25) and group AN (MoCA score≤25). Outcomes included the hospital length of stay (primary outcome), the length of stay in patients with PPCs (LOS-PPCs), the pulmonary complications (atelectasis, pulmonary infection, respiratory failure) and other complications (blood transfusion, chylothorax, new arrhythmia, myocardial infarction and acute cerebral infarction) (secondary outcomes). Data were analyzed using univariate and multivariate analyses. Results Seventy-four of 154 (49%) patients screened positive for probable mild cognitive impairment (MoCA ≤ 25) in the final analyses. The hospital length of stay and LOS-PPCs in elderly patients with mild cognitive impairment preoperatively were significantly longer than those with group N (P<0.05). Multivariate stepwise regression showed that preoperative MCI was an independent risk factor for prolonging the hospital length of stay and LOS-PPCs. Patients with a MoCA score less than or equal to 25 were more likely to have a longer hospital length of stay (OR = 2.355, 95% CI =1.137 to 4.877, P=0.021) and LOS-PPCs (OR = 6.867, 95% CI =1.116 to 42.257, P=0.038), but not related to increase the incidence of postoperative pulmonary complications (OR = 0.955, 95% CI =0.280 to 3.254, P=0.941) and other complications (OR = 1.687, 95% CI =0.502 to 5.665, P=0.398) compared to those with a MoCA score greater than 25. Conclusions The prevalence of undiagnosed probably mild cognitive impairment among elderly patients scheduled for thoracic surgery is high (49%). Such impairment is associated with a longer hospital stay and LOS-PPCs, while it is not possible to conclude that it is related to the incidence of pulmonary complications and other complications after surgery.

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Preoperative biochemical evaluation of the surgical patient

Cited by 4 publications

References 2 publications

Poor Performance on a Preoperative Cognitive Screening Test Predicts Postoperative Complications in Older Orthopedic Surgical Patients

Poor Performance on a Preoperative Cognitive Screening Test Predicts Postoperative Complications in Older Orthopedic Surgical Patients

Prevalence of preoperative cognitive impairment among elderly thoracic surgery patients and association with postoperative delirium: a prospective observational study

Prevalence of undiagnosed mild cognitive impairment in elderly patients undergoing thoracic surgery and its relationship with postoperative outcome: a prospective cohort study

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