Preoperative Cognitive Impairment As a Predictor of Postoperative Outcomes in a Collaborative Care Model.
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.
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https://hdl.handle.net/10161/16043Published Version (Please cite this version)
10.1111/jgs.15261Publication 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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Show full item recordScholars@Duke
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
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
Sandhya Anand Lagoo-Deenadayalan
Professor of Surgery
Shelley R McDonald
Associate Professor of Medicine
Kahli Zietlow
House Staff
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