Cognitive impairment is prevalent in older surgical patients; however, the condition is greatly under-recognized, and outcomes associated with it are poorly understood.
This 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.
A 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]).
We recommend a routine cognitive assessment in an emergency surgical setting whenever feasible to help identify patients at risk of poor outcomes.
Funded in part by the National Institute for Health Research (NIHR) Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London (BRC). A.D. Ablett was sponsored by Medical Research Scotland (MRS) for a summer research scholarship (Vac-1058-2017). MRS has no role in study design and interpretation of the study results.
Cardiff and Vale University Health Board: Maeve Middleton, Silas Fuller, Siti Abdul Jabar, Stephanie Thomas, Mathew Williams, Amy Black, Svetlana Kulikouskaya, Caroline Best, Andrew Forrester, Joseph Ereaut, James Moore, Dominic Hampson, Stephanie Owen, Shaanjan Islam, Nicolas Gill, Stephan Merrix, Jack Topham, Pip Killingworth, Syed Rahman, and Nurulaida Mohd Darus.
North Bristol NHS Trust: Madeline Tarant, Emily Benson, Tom Wright, Sarah Blake, Calum Honeyman, Simon Huf, Anni Dong, Indira Garaeva, Manuk Wijeyaratne, Michael Campbell, and Eng Hean the.
Royal Alexandra Hospital, Paisley: Mahua Chakrabati, Adam Tay, and Nurwasimah Haj Asnan.
NHS Grampian: Caroline McCormack, Tay Hui Sian, and Matthew Greig.
Central Manchester University Hospitals: Jen Law and Elizabeth Norr.