Preoperative Cognitive Stratification of Older Elective Surgical Patients: A Cross-Sectional Study.
Anesth Analg
; 123(1): 186-92, 2016 07.
Article
em En
| MEDLINE
| ID: mdl-27028776
ABSTRACT
BACKGROUND:
Preexisting cognitive impairment is emerging as a predictor of poor postoperative outcomes in seniors. We hypothesized that preoperative cognitive screening can be performed in a busy preadmission evaluation center and that cognitive impairment is prevalent in elective geriatric surgical patients.METHODS:
We approached 311 patients aged 65 years and older presenting for preoperative evaluation before elective surgery in a prospective, observational, single-center study. Forty-eight patients were ineligible, and 63 declined. The remaining 200 were randomly assigned to the Mini-Cog (N =100) or Clock-in-the-Box [CIB; N = 100)] test. Study staff administered the test in a quiet room, and 2 investigators scored the tests independently. Probable cognitive impairment was defined as a Mini-Cog ≤ 2 or a CIB ≤ 5.RESULTS:
The age of consenting patients was 73.7 ± 6.4 (mean ± SD) years. There were no significant differences between patients randomly assigned to the Mini-Cog and CIB test in age, weight, gender, education, ASA physical status, or Charlston Index. Overall, 23% of patients met criteria for probable cognitive impairment, and prevalence was virtually identical regardless of the test used; 22% screened with the Mini-Cog and 23% screened with the CIB scored as having probable cognitive impairment (P = 1.0 by χ analysis). Both tests had good interrater reliability (Krippendroff α = 0.86 [0.72-0.93] for Mini-Cog and 1 for CIB).CONCLUSIONS:
Preoperative cognitive screening is feasible in most geriatric elective surgical patients and reveals a substantial prevalence of probable cognitive impairment in this population.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Cuidados Pré-Operatórios
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Avaliação Geriátrica
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Cognição
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Procedimentos Cirúrgicos Eletivos
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Transtornos Cognitivos
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Testes Neuropsicológicos
Tipo de estudo:
Diagnostic_studies
/
Etiology_studies
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Observational_studies
/
Prevalence_studies
/
Prognostic_studies
/
Risk_factors_studies
Limite:
Aged
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Female
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Humans
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Male
País/Região como assunto:
America do norte
Idioma:
En
Revista:
Anesth Analg
Ano de publicação:
2016
Tipo de documento:
Article