Preoperative assessment of cognitive function and risk assessment of cognitive impairment in elderly patients with orthopedics: a cross-sectional study

Shuyuan Gan,Yang Yu,Yueying Zheng,Shengmei Zhu,Xiaodong Tang,Jiateng Wu,Mingcang Wang

doi:10.1186/s12871-020-01096-6

Shuyuan Gan, Yang Yu + Show 5 more

Open Access

https://doi.org/10.1186/s12871-020-01096-6

Copy DOI

Journal: BMC anesthesiology	Publication Date: Aug 1, 2020
Citations: 10	License type: open-access

Affiliation: Zhejiang University, Wenzhou Medical University

Abstract

BackgroundPreexisting cognitive impairment is emerging as a predictor of poor postoperative outcomes in seniors. Nevertheless, cognitive impairment in a large proportion of geriatric patients has not been well identified and diagnosed.MethodsThis is a cross-sectional study. Mini-mental state examination scale was used to assess the cognitive function of elderly patients aged ≥65 years undergoing orthopedic surgery preoperatively. The baseline, living habits and laboratory examination results of two groups were compared, and a multivariable logistic regression model was used to identify independent predictors of preoperative cognitive impairment.ResultsA total of 374 elderly patients with orthopedic surgery indications met the inclusion criteria, and 28.61% of them had preoperative cognitive impairment. Multivariable logistic regression analysis showed that age (OR = 1.089, P < 0.001), subjective sleep disorders (OR = 1.996, P = 0.021), atherosclerosis (OR = 2.367, P = 0.017), and high cholesterol level (OR = 1.373, P = 0.028) were independent risk factors for preoperative cognitive impairment, while high education level performed as a protective factor (compared with the illiterate group, primary school group: OR = 0.413, P = 0.009; middle school or above group: OR = 0.120, P < 0.001).ConclusionsThe prevalence of preoperative cognitive dysfunction in geriatric elective orthopedic surgical patients was high. Our study identified venerable age, low level of education, subjective sleep disorders, atherosclerosis, and high cholesterol level as risk factors for preoperative cognitive impairment in these patients. Understanding these risk factors contributes to assisting in prevention and directed interventions for the high-risk population.

Highlights

Preexisting cognitive impairment is emerging as a predictor of poor postoperative outcomes in seniors
The aim of this study was, to explore the prevalence of preoperative cognitive impairment in patients ≥65 years old with Minimental state examination (MMSE) and to examine the association of cognitive impairment with preoperative risk factors in an older population scheduled for orthopedic surgery
Categorical variables were summarized as frequencies and proportions, normally distributed continuous variables were expressed as the mean, and nonnormally distributed continuous variables were expressed as median

Summary

Introduction

Preexisting cognitive impairment is emerging as a predictor of poor postoperative outcomes in seniors. Last but not the least, delirium is arguably one of the most important postoperative complications, affecting 20–80% of patients older than 65 Among these surgical patients, preexisting cognitive impairment, as well as an increased duration of surgery and receiving a general anesthetic, are associated with an increased risk for postoperative delirium (POD) and other surgical outcomes [9,10,11]. Clinical interventions, such as interoperative infusion of dexmedetomidine, are protective factors [12, 13]. Diagnosis of preoperative cognitive impairment enables early identification of at-risk patients and timely management of postoperative cognitive complications to reduce the occurrence [14]

Objectives

Methods

Results

Discussion

Conclusion