• Surgery · May 2019

    Multicenter Study

    Cognitive impairment is associated with mortality in older adults in the emergency surgical setting: Findings from the Older Persons Surgical Outcomes Collaboration (OPSOC): A prospective cohort study.

    • Andrew D Ablett, Kathryn McCarthy, Ben Carter, Lyndsay Pearce, Michael Stechman, Susan Moug, Jonathan Hewitt, Phyo K Myint, and Older Persons Surgical Outcomes Collaboration.
    • Institute of Applied Health Sciences, University of Aberdeen, UK.
    • Surgery. 2019 May 1; 165 (5): 978-984.

    BackgroundCognitive impairment is prevalent in older surgical patients; however, the condition is greatly under-recognized, and outcomes associated with it are poorly understood.MethodsThis is a prospective multicenter cohort study of unselected consecutive older adults admitted to 5 emergency general surgical units across the United Kingdom participating in the Older Persons Surgical Outcomes Collaboration from 2013-2014. The effect of moderate cognitive impairment defined as ≤17, bottom quartile of Montreal Cognitive Assessment was examined using multivariate logistic regression models. Primary outcome measure was the relationship between a low Montreal Cognitive Assessment score (≤17) and mortality at 30 and 90 days. Secondary outcome measures included the association between having a low Montreal Cognitive Assessment and hospital length of stay.ResultsA total of 539 older patients admitted consecutively to 5 surgical units during the 2013 and 2014 study periods were included. The median age (interquartile range) was 76 years (70-82 years), the emergency operation rate was 13% (n = 72). The prevalence of cognitive impairment, using the traditional Montreal Cognitive Assessment cutoff score of ≤26, was 84.4% and, using the recently suggested cutoff score of ≤23, the prevalence was 61.0%. Multivariable analyses showed patients with a low Montreal Cognitive Assessment score (≤17) had a three-fold increase in 30-day mortality (adjusted odds ratio = 3.10; 95% confidence interval:1.19-8.11; P = .021) and an increased length of hospital stay (10 or more days; 1.80 [1.10-2.94; P = .02] and 14 or more days; 2.06 [1.17-3.61; P = .012]).ConclusionWe recommend a routine cognitive assessment in an emergency surgical setting whenever feasible to help identify patients at risk of poor outcomes.Copyright © 2018 Elsevier Inc. All rights reserved.

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