Journal of Cardiothoracic and Vascular Anesthesia
Original ResearchThe Prevalence and Impact of Undiagnosed Mild Cognitive Impairment in Elderly Patients Undergoing Thoracic Surgery: A Prospective Cohort Study
Section snippets
Methods and Materials
This prospective cohort study enrolled 170 elderly patients from November 7, 2018, to April, 1, 2019, at the Shanghai Chest Hospital. Patients with a history of schizophrenia or dementia, uncorrected vision or hearing impairment, and refusal to participate were excluded. A total of 154 elderly patients completed the Chinese version of the MoCA test preoperatively and were included in the final analysis. This study was approved by the Institutional Review Board (KS1862) of Shanghai Jiao Tong
Results
A total of 154 elderly patients aged 65 years or older scheduled for thoracic surgery were included in the final analysis (Fig 1). The incidence of MCI and postoperative delirium in elderly patients was 49.4% (76 of 154) and 22% (34 of 154), respectively. There were no significant differences in demographic and baseline characteristics between the 2 groups (Table 1).
Compared with group N, MCI could increase the incidence of POD (14.1% v 30.3%, p = 0.016) and median LOS (4 d v 5 d, p = 0.016).
Discussion
The incidence of MCI before thoracic surgery in elderly patients was higher and associated with a higher rate of POD and prolonged median LOS. In addition, compared with the elderly patients without POD, POD could increase the risk of PPCs and median LOS. Preoperative MCI screening may help to provide interventions for patients at greatest risk of adverse outcomes after surgery, thereby benefiting them.
The Chinese version of the MoCA scale is mainly used to evaluate MCI in elderly patients,
Conclusions
The incidence of MCI before thoracic surgery in elderly patients was higher and associated with a higher rate of postoperative adverse outcomes. The findings may be important for preoperative patient counseling, operative planning, and eventually reducing potential risk exposure and related outcomes.
Acknowledgements
The authors would like to thank the nurse anesthesiologists in the operating room of the Shanghai Chest Hospital, Shanghai, the People's Republic of China, for their involvement and support.
Conflict of Interest
None of the authors has financial relationships with any companies or entities that make products pertinent to the paper.
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Association between postoperative delirium and adverse outcomes in older surgical patients: A systematic review and meta-analysis
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2022, Journal of Clinical AnesthesiaCitation Excerpt :We combined elective and emergency studies to perform one meta-analysis per postoperative outcome. The elective surgery group consisted of 27 studies (10,634 patients), with a mean age ± SD (range) of 74.9 ± 9.9 (66–89) years and 46.5% women [14,16–40,67]. Unrecognized and diagnosed CI were identified in 8269 and 2365 patients respectively.
Prevalence of preoperative cognitive impairment in older surgical patients.: A systematic review and meta-analysis
2022, Journal of Clinical AnesthesiaCitation Excerpt :We included 32 prospective cohort studies, 11 retrospective cohort studies, four secondary analysis studies, and one cross-sectional study. Thirty-five studies were elective non-cardiac surgeries (25 unrecognized [29–53], 10 diagnosed [54–63]), four were elective cardiac surgeries (all unrecognized) [64–67], and six were emergency surgeries (five unrecognized [68–74], two diagnosed [75,76]). Twenty-two studies were classified as non-cardiac mixed surgery [29–44,54–59], 10 as orthopedic (spinal surgery/THA/TKA) [45–50,60–63], four as cardiac [64–67], three as vascular [51–53], and three as emergency general surgeries [72–74].
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This work was supported by the Shanghai Municipal Science and Technology Committee (Western Medicine Guided Project) 16411967600 Fund and Shanghai Municipal Commission of Health and Family Planning Project 201840319.