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

Publication ,  Journal Article
Zietlow, K; McDonald, SR; Sloane, R; Browndyke, J; Lagoo-Deenadayalan, S; Heflin, MT
Published in: J Am Geriatr Soc
March 2018

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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Published In

J Am Geriatr Soc

DOI

EISSN

1532-5415

Publication Date

March 2018

Volume

66

Issue

3

Start / End Page

584 / 589

Location

United States

Related Subject Headings

  • Risk Factors
  • Retrospective Studies
  • Preoperative Period
  • Postoperative Period
  • Postoperative Complications
  • Patient Discharge
  • Middle Aged
  • Male
  • Humans
  • Geriatrics
 

Citation

APA
Chicago
ICMJE
MLA
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Zietlow, K., McDonald, S. R., Sloane, R., Browndyke, J., Lagoo-Deenadayalan, S., & Heflin, M. T. (2018). Preoperative Cognitive Impairment As a Predictor of Postoperative Outcomes in a Collaborative Care Model. J Am Geriatr Soc, 66(3), 584–589. https://doi.org/10.1111/jgs.15261
Zietlow, Kahli, Shelley R. McDonald, Richard Sloane, Jeffrey Browndyke, Sandhya Lagoo-Deenadayalan, and Mitchell T. Heflin. “Preoperative Cognitive Impairment As a Predictor of Postoperative Outcomes in a Collaborative Care Model.J Am Geriatr Soc 66, no. 3 (March 2018): 584–89. https://doi.org/10.1111/jgs.15261.
Zietlow K, McDonald SR, Sloane R, Browndyke J, Lagoo-Deenadayalan S, Heflin MT. Preoperative Cognitive Impairment As a Predictor of Postoperative Outcomes in a Collaborative Care Model. J Am Geriatr Soc. 2018 Mar;66(3):584–9.
Zietlow, Kahli, et al. “Preoperative Cognitive Impairment As a Predictor of Postoperative Outcomes in a Collaborative Care Model.J Am Geriatr Soc, vol. 66, no. 3, Mar. 2018, pp. 584–89. Pubmed, doi:10.1111/jgs.15261.
Zietlow K, McDonald SR, Sloane R, Browndyke J, Lagoo-Deenadayalan S, Heflin MT. Preoperative Cognitive Impairment As a Predictor of Postoperative Outcomes in a Collaborative Care Model. J Am Geriatr Soc. 2018 Mar;66(3):584–589.
Journal cover image

Published In

J Am Geriatr Soc

DOI

EISSN

1532-5415

Publication Date

March 2018

Volume

66

Issue

3

Start / End Page

584 / 589

Location

United States

Related Subject Headings

  • Risk Factors
  • Retrospective Studies
  • Preoperative Period
  • Postoperative Period
  • Postoperative Complications
  • Patient Discharge
  • Middle Aged
  • Male
  • Humans
  • Geriatrics