Presentation Details
| Risk Stratification of Older Surgical Patients Using an Ultra-Rapid, Self-Reported Questionnaire: Insights From Two Multicenter Longitudinal Studies. Ellene Yan1, 2, 3, Yasmin Alhamdah1, 2, 3, Nina Butris1, 2, 3, Paras Kapoor1, 2, 3, Aparna Saripella2, Frances Chung1, 2, 3. 1Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.2Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada.3Krembil Brain Institute, University Health Network, Toronto, ON, Canada |
Abstract
BACKGROUND: Preoperative identification of cognitive impairment (CI) can enhance risk stratification. The preoperative utility of the Ascertain Dementia Eight-item Questionnaire (AD8), an ultra-rapid cognitive screening tool, in identifying at-risk patients had not been comprehensively studied. Using data from two multicenter longitudinal studies, this post-hoc analysis explored the associations of preoperative CI using the AD8, its individual items, and domain-specific impairments (memory and executive function) with adverse postoperative outcomes.
METHODS: Following ethics approval, 689 elective non-cardiac surgical participants aged ≥65 years were recruited across two multicenter longitudinal studies. We excluded those with major neurocognitive disorder, uncorrected sensory impairment, alcohol or substance abuse, or those having ambulatory, vascular, or neurosurgical procedures. Preoperative CI was screened using the self-reported AD8 (cut-off ≥2), which assessed judgement, apathy, repetition, learning, orientation, finances, remembering, and daily thinking/memory. The following clinical outcomes were collected for all participants at 30 days and 686 participants at 90 days: postoperative delirium, all-cause complications, length of stay, non-home discharge, emergency department visits, readmission, mortality, and composite adverse outcomes.
RESULTS: Of 689 participants, 15% screened positive for CI preoperatively using the AD8. CI was associated with greater postoperative delirium (4-fold), 90-day complications (2-fold), and 90-day composite adverse outcomes (2-fold), after adjusting for age, sex, surgery, and/or American Society of Anesthesiologists physical status class (Table 1). Of all AD8 items, repetition was associated with the greatest number of adverse outcomes after confounder and multiplicity adjustments, including postoperative delirium (6-fold), 30-day complications (3-fold), and 30-day composite adverse outcomes (3-fold) (Figure 1). Similarly, memory-related problems had higher adjusted odds of postoperative delirium (5-fold), complications (77%), and composite adverse outcomes (2-fold) at 30 days postoperatively (Figure 1).
CONCLUSIONS: Of all AD8 items, the question on repetition was associated with the greatest number of adverse outcomes at 30 days postoperatively, highlighting its utility in identifying at-risk patients.
No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author.
METHODS: Following ethics approval, 689 elective non-cardiac surgical participants aged ≥65 years were recruited across two multicenter longitudinal studies. We excluded those with major neurocognitive disorder, uncorrected sensory impairment, alcohol or substance abuse, or those having ambulatory, vascular, or neurosurgical procedures. Preoperative CI was screened using the self-reported AD8 (cut-off ≥2), which assessed judgement, apathy, repetition, learning, orientation, finances, remembering, and daily thinking/memory. The following clinical outcomes were collected for all participants at 30 days and 686 participants at 90 days: postoperative delirium, all-cause complications, length of stay, non-home discharge, emergency department visits, readmission, mortality, and composite adverse outcomes.
RESULTS: Of 689 participants, 15% screened positive for CI preoperatively using the AD8. CI was associated with greater postoperative delirium (4-fold), 90-day complications (2-fold), and 90-day composite adverse outcomes (2-fold), after adjusting for age, sex, surgery, and/or American Society of Anesthesiologists physical status class (Table 1). Of all AD8 items, repetition was associated with the greatest number of adverse outcomes after confounder and multiplicity adjustments, including postoperative delirium (6-fold), 30-day complications (3-fold), and 30-day composite adverse outcomes (3-fold) (Figure 1). Similarly, memory-related problems had higher adjusted odds of postoperative delirium (5-fold), complications (77%), and composite adverse outcomes (2-fold) at 30 days postoperatively (Figure 1).
CONCLUSIONS: Of all AD8 items, the question on repetition was associated with the greatest number of adverse outcomes at 30 days postoperatively, highlighting its utility in identifying at-risk patients.
No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author.
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