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

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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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Zietlow, Kahli, Shelley R McDonald, Richard Sloane, Jeffrey Browndyke, Sandhya Lagoo-Deenadayalan and Mitchell T Heflin (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

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Shelley R McDonald

Associate Professor of Medicine

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 perioperative care of frail older adults.   I served as Geriatrics Fellowship Program Director for 11 years and, over the same span, directed HRSA funded Geriatrics Education Programs at Duke, including our Geriatric Workforce Enhancement Program (GWEP) In that role, I worked with colleagues and community partners to provide IP educational programs in geriatrics and care redesign in primary care practices to improve care for older adults.  Concurrently, I also led the implementation of the Duke Perioperative Optimization of Senior Health (POSH) program and co-directed the VA OAA funded Specialty Care Education Center of Excellence for the VA POSH Program.  In my current role as Associate Dean and Director of the IPEC Center, I am working with educators and clinicians from across the Health System in the design and implementation of educational program aimed at improving our ability to use interprofessional collaborative practice to deliver safe, effective, person-centered care.

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