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Preoperative Cognitive Impairment As a Predictor of Postoperative Outcomes in a Collaborative Care Model.

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Date
2018-01-13
Authors
Zietlow, Kahli
McDonald, Shelley R
Sloane, Richard
Browndyke, Jeffrey
Lagoo-Deenadayalan, Sandhya
Heflin, Mitchell T
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Abstract
OBJECTIVES: To compare postoperative outcomes of individuals with and without cognitive impairment enrolled in the Perioperative Optimization of Senior Health (POSH) program at Duke University, a comanagement model involving surgery, anesthesia, and geriatrics. DESIGN: Retrospective analysis of individuals enrolled in a quality improvement program. SETTING: Tertiary academic center. PARTICIPANTS: Older adults undergoing surgery and referred to POSH (N = 157). MEASUREMENTS: Cognitive impairment was defined as a score less than 25 out of 30 (adjusted for education) on the St. Louis University Mental Status (SLUMS) Examination. Median length of stay (LOS), mean number of postoperative complications, rates of postoperative delirium (POD, %), 30-day readmissions (%), and discharge to home (%) were compared using bivariate analysis. RESULTS: Seventy percent of participants met criteria for cognitive impairment (mean SLUMS score 20.3 for those with cognitive impairment and 27.7 for those without). Participants with and without cognitive impairment did not significantly differ in demographic characteristics, number of medications (including anticholinergics and benzodiazepines), or burden of comorbidities. Participants with and without cognitive impairment had similar LOS (P = .99), cumulative number of complications (P = .70), and 30-day readmission (P = .20). POD was more common in those with cognitive impairment (31% vs 24%), but the difference was not significant (P = .34). Participants without cognitive impairment had higher rates of discharge to home (80.4% vs 65.1%, P = .05). CONCLUSION: Older adults with and without cognitive impairment referred to the POSH program fared similarly on most postoperative outcomes. Individuals with cognitive impairment may benefit from perioperative geriatric comanagement. Questions remain regarding the validity of available measures of cognition in the preoperative period.
Type
Journal article
Subject
co-management
cognitive impairment
older adults
postoperative outcomes
Permalink
https://hdl.handle.net/10161/16043
Published Version (Please cite this version)
10.1111/jgs.15261
Publication Info
Zietlow, Kahli; McDonald, Shelley R; Sloane, Richard; Browndyke, Jeffrey; Lagoo-Deenadayalan, Sandhya; & Heflin, Mitchell T (2018). Preoperative Cognitive Impairment As a Predictor of Postoperative Outcomes in a Collaborative Care Model. J Am Geriatr Soc. 10.1111/jgs.15261. Retrieved from https://hdl.handle.net/10161/16043.
This is constructed from limited available data and may be imprecise. To cite this article, please review & use the official citation provided by the journal.
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Scholars@Duke

Browndyke

Jeffrey Nicholas Browndyke

Associate Professor of Psychiatry and Behavioral Sciences
Dr. Browndyke is an Associate Professor of Behavioral Health & Neurosciences in the Department of Psychiatry & Behavioral Sciences.  He has a secondary appointment as Assistant Professor of Cardiovascular & Thoracic Surgery.Dr. Browndyke's research interests involve the use of advanced neurocognitive and neuroimaging techniques for perioperative contributions to delirium and later dementia risk, monitoring of late-life neuropathological disease progression, and inter
Heflin

Mitchell Tod Heflin

Professor of Medicine
I am currently a Professor with Tenure in the Department of Medicine, a Senior Fellow in the Duke Center for the Study of Aging and Human Development, and Associate Dean for Interprofessional Education and Care (IPEC).  My career as a leader in Geriatrics has focused on development, deployment and evaluation of education programs aimed at health professions learners from a variety of disciplines and introduction of innovative models of care with a specific emphasis on community-based and pe
Lagoo-Deenadayalan

Sandhya Anand Lagoo-Deenadayalan

Professor of Surgery
McDonald

Shelley R McDonald

Associate Professor of Medicine
Zietlow

Kahli Zietlow

House Staff
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