Preoperative cognitive function in very old patients : Influence on the complication rate and length of hospitalization

Abstract

Gastrointestinal cancer is afrequent diagnosis in older patients. Acurative resection, possibly in combination with radiotherapy and/or chemotherapy, is the standard therapy. The advanced age of the patients with an increasing number of comorbidities and often the presence of cognitive impairment represents ahigh risk for perioperative complications and alonger stay in hospital. The challenge in the clinical routine is to recognize a cognitive impairment in older patients and to prepare these patients for the operative intervention in the best possible way. This retrospective analysis was carried out to find out whether preoperative cognitive impairment is aprognostic factor for the postoperative outcome. In patients over the age of 75years who were prepared for abdominal surgery of gastrointestinal cancer in the preoperative consultation, the mini mental state examination (MMSE) and the clock test were carried out. The results of the tests were retrospectively compared with the complication rate and the duration of hospital stay. Low MMSE values were significantly associated with the complication rate and the development of asevere complication (Clavien-Dindo grade ≥ 3a). Acut-off value of 24points in the MMSE was predictive for the development of complications and alonger hospital stay. The age of the patients was not associated with the MMSE. Cognitive impairment is an important prognostic factor for the development of perioperative complications and the duration of the hospital stay in patients undergoing extensive abdominal surgery for gastrointestinal cancer. Therefore, apreoperative assessment, for example with the MMSE, is recommended in order to identify high-risk patients.