The Influence of Cognitive Impairment on Postoperative Outcomes

Abstract

Objective: To examine differences in rates of elective surgery, postoperative mortality, and readmission by pre-existing cognitive status among Medicare beneficiaries undergoing surgery. Background: MCI is common among older adults, but the impact of MCI on surgical outcomes is understudied. Methods: We conducted a retrospective cohort study of individuals ≥65 who underwent surgery between 2001 and 2015 using data from the nationally-representative Health and Retirement Study linked with Medicare claims. Cognitive status was assessed by the modified telephone interview for cognitive status score and categorized as normal cognition (score: 12-27), MCI (7-11), and dementia ( < 7). Outcomes were 30-and 90-day postoperative mortality and readmissions. We used Cox proportional hazard models to estimate the risk of each outcome by cognition, adjusting for patient characteristics. Results: In 6,590 patients, 69.9% had normal cognition, 20.1% had MCI, and 9.9% had dementia. Patients with MCI (79.9%) and dementia (73.6%) were less likely to undergo elective surgery than patients with normal cognition (85.9%). Patients with MCI had similar postoperative mortality and readmissions rates as patients with normal cognition. However, patients with dementia had significantly higher postoperative 90-day mortality (5.2% vs 8.4%, P = 0.002) and readmission rates (13.9% vs 17.3%, P = 0.038). Conclusion: Patients with self-reported MCI are less likely to undergo elective surgery but have similar postoperative outcomes compared with patients with normal cognition. Despite the variability of defining MCI, our findings suggest that MCI may not confer additional risk for older individuals undergoing surgery, and should not be a barrier for surgical care.

Surgical outcomes and healthcare expenditures among patients with dementia undergoing major surgery

“…2,3 This demographic transition has created significant healthcare challenges, as older individuals are more susceptible to diseases and at risk for suboptimal clinical outcomes due to age-related comorbid conditions, such as Alzheimer's disease and related dementias (ADRD). 4,5 ADRD encompasses a broad range of cognitive deficiencies that may result in memory deficits, functional decline, delirium, and reduced rehabilitation potential, ultimately leading to poor outcomes. 5,6 Surgical procedures among older individuals have increased over the last several decades, with approximately 1 in 8 elderly individuals requiring surgery.…”

“…4,5 ADRD encompasses a broad range of cognitive deficiencies that may result in memory deficits, functional decline, delirium, and reduced rehabilitation potential, ultimately leading to poor outcomes. 5,6 Surgical procedures among older individuals have increased over the last several decades, with approximately 1 in 8 elderly individuals requiring surgery. 7 Of note, 37% of non-cardiac surgery patients have some degree of cognitive impairment.…”

“…Approximately 16.8% (55.8 million) of the population is 65 or older, with an expected surge to 98 million by 2060 2,3 . This demographic transition has created significant healthcare challenges, as older individuals are more susceptible to diseases and at risk for suboptimal clinical outcomes due to age‐related comorbid conditions, such as Alzheimer's disease and related dementias (ADRD) 4,5 . ADRD encompasses a broad range of cognitive deficiencies that may result in memory deficits, functional decline, delirium, and reduced rehabilitation potential, ultimately leading to poor outcomes 5,6 …”

Outcomes with spinal versus general anesthesia for patients with and without preoperative cognitive impairment: Secondary analysis of a randomized clinical trial

“…Postoperative delirium occurs in 11%–45% of older surgical patients and is associated with postoperative mortality, cognitive decline, increased hospital length of stay, and higher health care costs 1–6 . The risk of postoperative delirium is elevated in persons with preoperative cognitive impairment 7–10 . Compared to general anesthesia, spinal anesthesia has been suggested to reduce the likelihood of postoperative delirium for persons with cognitive impairment 11,12 .…”

“…[1][2][3][4][5][6] The risk of postoperative delirium is elevated in persons with preoperative cognitive impairment. [7][8][9][10] Compared to general anesthesia, spinal anesthesia has been suggested to reduce the likelihood of postoperative delirium for persons with cognitive impairment. 11,12 However, as prior studies comparing spinal versus general anesthesia have often excluded individuals with cognitive impairment, little is known regarding outcomes of spinal versus general anesthesia in this population.…”