Preoperative Cognitive Impairment as a Perioperative Risk Factor in Patients Undergoing Total Knee Arthroplasty

Abstract

Background: The study assessed whether pre-existing cognitive impairment (CI) prior to elective total knee arthroplasty (TKA) is associated with worse postoperative outcomes such as delirium, in-hospital medical complications, 30-day mortality, hospital length of stay and non-home discharge. Methods: A retrospective database analysis from the NSQIP Geriatric Surgery Pilot Project was used. There was an initial cohort of 6350 patients undergoing elective TKA, 104 patients with CI were propensity score matched to 104 patients without CI. Results: Analysis demonstrated a significantly increased incidence of post-operative delirium (POD) in the cohort with pre-op CI (p = < .001), a worsened functional status (p = < .001) and increased nonhome discharge postoperatively compared to the group without CI (p = 0.029). Other post-operative outcomes included 30-day mortality of 0% in both groups, and low rate of complications such as infection (2.88% vs 0.96%), pneumonia (1.92% vs 0%), failure to wean (0.96% vs 0%), and reintubation (0.96% vs 0%). Some other differences between the CI group and non-CI group, although not statistically significant, included increased rate of transfusion (10.58% vs 6.73%), and sepsis (1.92% vs 0%). The length of stay was increased in the non-CI group (4.28% vs 2.32%, p = 0.122). Conclusion: CI in patients undergoing TKA is associated with an increased risk of POD, worsened postoperative functional status, and discharge to non-home facility.

Effects of regional cerebral oxygen saturation monitoring on postoperative cognitive dysfunction in older patients: a systematic review and meta-analysis

“…POCD is more frequent and lasts longer in older patients following surgery under anesthesia, which may be mainly due to degenerative changes in the structure of the brain and a progressive decline in reserve function [36]. It is generally accepted that advanced age, especially pre-existing cognitive impairment, is associated with a high incidence of POCD [37,38]. Episodes of cerebral ischemia and hypoxia have been regarded as the most closely related to POCD among distinct etiological factors [39][40][41].…”

Cognitive impairment and its adverse outcomes in older surgical patients: an under-recognized problem!

“…Emerging evidence suggests that preoperative CI increases the risk of having poor postoperative functional outcomes 29. Similarly, a retrospective study reported that older patients with preoperative CI undergoing orthopedic surgery were at a greater risk of becoming partially or fully dependent on their activities of daily living than those without CI 53. In cardiac surgery, one study suggested that preoperative cognitive assessment would provide a more accurate prediction of reduced activities of daily living within 6 months of surgery than preoperative functional assessments 54…”

Addressing comorbidities in the perioperative setting and optimizing perioperative medicine education

“…Postoperative delirium (POD) is a syndrome that can manifest in patients one to 3 days postoperatively [5]. This syndrome can have detrimental long-term effects on patients in addition to increased burden on the healthcare system [5]. POD is associated with increased postoperative complications, longer length of hospital stay and higher rates of discharge to an acute care facility [6].…”

“…This initiative was started to reduce the impact of preexisting cognitive deficits and optimize cognitive recovery in adults 65 and older undergoing surgery. Postoperative delirium (POD) is a syndrome that can manifest in patients one to 3 days postoperatively [5]. This syndrome can have detrimental long-term effects on patients in addition to increased burden on the healthcare system [5].…”