Abstract
Preoperative cognitive impairment (PCI) in cancer patients includes a broad spectrum of neurocognitive changes produced by complex interplay of patient, tumoural and treatment-related factors. Reduced preoperative cognitive reserve can favour the emergence of postoperative delirium (POD). The study aims to document PCI prevalence and to assess the relationship with POD in elderly cancer patients. The prospective observational study included consecutive patients scheduled for elective surgery; PCI was assessed with Mini-Cog test and defined at a score ≤ 3, POD was screened using Nursing Delirium Screening Scale (Nu-DESC) and defined at a score ≥ 2. Data on education, American Society of Anesthesiologists (ASA) score, preoperative medications, substance use, comorbidities, sensorial deficits, surgery and anaesthesia type, anaesthetic drugs, Mini-Cog score, postoperative pain, Nu-DESC were collected. In total, 131 patients were enrolled, mean age 72.1 ± 5.9 years. PCI prevalence was 51.9% (n = 68). POD prevalence was 19.8% (n = 26), with significantly higher value in PCI patients (27.9% vs. 11.1%, p = 0.016). In multivariate analysis, Mini-Cog score ≤ 3 (OR = 2.6, p = 0.027), clock draw (OR: 2.9, p = 0.013), preoperative renal dysfunction (OR = 2.6, p = 0.012), morphine (OR = 2.7, p = 0.007), metoclopramide (OR = 6.6, p = 0.006), and high pain score (OR = 1.8, p = 0.018) had a significant association with POD development. In this sample of elderly patients, PCI had a high prevalence and predicted the emergence of POD. Incorporating Mini-Cog test into the preoperative evaluation of onco-geriatric patients seems valuable and feasible.
Highlights
The number of elderly cancer patients undergoing diagnostic, curative, supportive or palliative surgical interventions is significantly increasing
We screened the cognitive function of elderly cancer patients with Mini-Cog test prior to elective surgery and we investigate the relationship of the Mini-Cog score to the development of postoperative delirium (POD)
Between January and April 2018, 668 surgical cancer patients were screened during the preanesthetic assessment; of these, 526 (78.7%) patients were excluded based on age, planned postoperative ICU admission, day or emergency surgery
Summary
The number of elderly cancer patients undergoing diagnostic, curative, supportive or palliative surgical interventions is significantly increasing. Older adults (aged 65 years and more) are currently the fastest-growing segment of the population in many countries around the world and the number is expected to further increase. Cancer incidence in elderly patients is projected to increase with 67% by 2030, generating a concomitant rise in the number of cancer surgeries [2,3]. It is estimated that, in 2030, out of 21.6 million new cancer cases, about 17.3 million will need surgery and 10 million of those patients will be from low- and middle-income countries [4]. Preoperative cognitive impairment (PCI) includes a broad spectrum of neurocognitive changes, varying from mild cognitive impairment to dementia, and consists of the decline of one or more key domains of the cognitive functions (memory, language, visuospatial, executive functioning, calculation) [5,6]. Older adults with impaired cognition tend to have an increased rate of postoperative complications [7,8]
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