November 7, 2017

Preop cognitive screening predicts postop complications in older total joint patients

By: Judy Mathias

Editor’s Note

Poor preoperative cognition, as assessed by preoperative Mini-Cog screening, is prevalent among older total joint patients and predictive of adverse outcomes, including postoperative delirium, longer hospital stay, and greater likelihood of discharge to a place other than home, this study finds.

Of 211 patients 65 years of age or older without a diagnosis of dementia who were scheduled for total joint replacement, 50 (24%) screened positive for probable cognitive impairment (Mini-Cog ≤ 2).

On age-adjusted, multivariate analysis, patients with a Mini-Cog ≤ 2 were more likely to:

  • be discharged to a place other than home (67% vs 34%)
  • develop postoperative delirium (21% vs 7%)
  • have a longer hospital length of stay (1.12 days longer).

Preoperative cognitive screening may be valuable for risk assessment and risk stratification of older surgical patients, the authors say.

APPROXIMATELY one of every three surgical procedures nationally is performed on a patient 65 yr of age or older. There is intense interest in identifying predictors of adverse outcomes in this age group, given that they have a high complication rate and often do poorly.1–4  Preoperative assessment of major vital organs has been a routine part of preparation for surgery for decades5,6  but brain function is typically not formally evaluated.7 

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