Frailty Is Associated With Postoperative Delirium But Not With Postoperative Cognitive Decline in Older Noncardiac Surgery Patients
| Autor: | Frederick E. Sieber, Hung-Mo Lin, Kenneth S. Boockvar, Kathy Zhang, Elizabeth Mahanna-Gabrielli, Stacie Deiner, Xiaoyu Liu, Margaret Sewell |
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| Rok vydání: | 2020 |
| Předmět: |
Male
Pediatrics medicine.medical_specialty Frail Elderly Trail Making Test Neuropsychological Tests Severity of Illness Index Article Cognition Postoperative Complications Postoperative Cognitive Complications Risk Factors Surveys and Questionnaires Severity of illness Humans Medicine Prospective Studies Cognitive decline Prospective cohort study Geriatric Assessment Aged Frailty business.industry Delirium Wechsler Adult Intelligence Scale Electroencephalography Perioperative medicine.disease Anesthesiology and Pain Medicine Elective Surgical Procedures Data Interpretation Statistical Mental Recall Female medicine.symptom Cognition Disorders business Postoperative cognitive dysfunction Follow-Up Studies |
| Zdroj: | Anesth Analg |
| ISSN: | 0003-2999 |
| Popis: | BACKGROUND: Postoperative cognitive dysfunction (POCD) and delirium are the most common perioperative cognitive complications in older adults undergoing surgery. A recent study of cardiac surgery patients suggests that physical frailty is a risk factor for both complications. We sought to examine the relationship between preoperative frailty and postoperative delirium and preoperative frailty and POCD after major noncardiac surgery. METHODS: We performed a prospective cohort study of patients greater than 65 years-old having major elective noncardiac surgery with general anesthesia. Exclusion criteria were preexisting dementia, inability to consent, cardiac, intracranial or emergency surgery. Preoperative frailty was determined using the FRAIL scale, a simple questionnaire which categorizes patients as robust, prefrail, or frail. Delirium was assessed with the confusion assessment method for the intensive care unit (CAM-ICU) twice daily, starting in the recovery room until hospital discharge. All patients were assessed with neuropsychological tests (California Verbal Learning Test II, Trail Making Test, subtests from the Wechsler Adult Intelligence Scale, Logical Memory Story A, Immediate and Delayed Recall, Animal and Vegetable verbal fluency, Boston Naming Test, and the Mini-Mental Status Exam) prior to surgery and at 3 months afterwards. RESULTS: 178 patients met inclusion criteria; 167 underwent major surgery and 150 were available for follow up 3 months after surgery. The median age was 70 years old. 31 patients (18.6%) tested as frail, and 72 (43.1%) prefrail prior to surgery. After adjustment for baseline cognitive score, age, education, surgery duration, American Society of Anesthesiology (ASA) status, type of surgery, and gender, patients who tested frail or prefrail had an estimated 2.7 times the odds of delirium (97.5% confidence interval 1.0– 7.3) when compared to patients who were robust. There was no significant difference between the proportion of POCD between patients who tested as frail, prefrail or robust. CONCLUSIONS: After adjustment for baseline cognition, testing as frail or prefrail with the FRAIL Scale is associated with increased odds of postoperative delirium, but not postoperative cognitive dysfunction after noncardiac surgery. |
| Databáze: | OpenAIRE |
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