Abstract
BackgroundPerioperative cognitive impairment (CI) following surgeries is prevalent in geriatric surgical population aged 60 and older. This meta-analysis was designed to investigate whether the Mini-Mental State Examination (MMSE) has prognostic value on adverse outcomes in aged surgical patients.MethodsPubMed, Cochrane, Embase and Medline through the Ovid were searched. Meta-analyses were carried out for CI versus non-cognitive impairment (NCI). Quality of evidence was assessed by the GRADE approach.ResultsOne randomized controlled trial, two retrospective cohort trials, and 18 prospective cohort trials were included in the meta-analysis. Perioperative diagnosis of CI by the MMSE had higher rates of patients suffering from postoperative delirium (POD) [odd ratio (OR) 5.02, 95% confidence interval (CI) 3.27, 7.71, P < 0.00001], in-hospital mortality (OR 7.51, 95% CI 2.17, 26.02, P = 0.001), mortality within 1 year (OR 2.53, 95% CI 1.95,3.29, P < 0.00001). Postoperative CI patients had no extended length of stay in orthopedic [standardized mean difference (SMD) -0.10, 95% CI -0.20, 0.17, P = 0.91)] nor rehabilitation wards ((SMD, 0.04; 95% CI, − 0.23 to 0.31; P = 0.78).ConclusionOlder patients with perioperative CI were more likely to suffer from POD and mortality. The MMSE showed certain value on risk stratification and prognosis evaluation in geriatric surgical population.Trial registrationPROSPERO CRD42018108739.
Highlights
Perioperative cognitive impairment (CI) following surgeries is prevalent in geriatric surgical population aged 60 and older
In the subgroup of postoperative Mini-Mental State Examination (MMSE) for the outcome of postoperative delirium, we found that the postoperative CI group showed a higher rate (OR, 0.07; 95% CI, 0.01 to 0.45; P = 0.006; I2 = 66%) after excluding the
The principal findings of our meta-analysis are that older patients with perioperative diagnoses of cognitive impairment by the MMSE had higher risk of postoperative delirium, in-hospital mortality and mortality within 1 year
Summary
PubMed, Cochrane, Embase and Medline through the Ovid were searched. Meta-analyses were carried out for CI versus non-cognitive impairment (NCI). Quality of evidence was assessed by the GRADE approach. Data sources and search strategy This systematic review was performed and presented following the principles of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement [13] and Assessing the Methodological Quality of Systematic Reviews (AMSTAR) guidelines. The protocol was registered with the International Prospective Register of Systematic Reviews A systematic literature search was conducted for studies published from 1995 to April 2018 by searching PubMed, the Cochrane Library, Embase and Medline through Ovid. The sensitive search was performed by using the following terms: “cognition”, “cognitive”, “delirium”, “complication”, “outcome”, “length of stay”, “surgery”, “operation”, “operative”, “procedure”, “Mini-Mental State Examination”, “MMSE”. The literature search strategy is provided in Additional file 1: Material 1
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