دورية أكاديمية
Agreement Between the Mini-Cog in the Preoperative Clinic and on the Day of Surgery and Association With Postanesthesia Care Unit Delirium: A Cohort Study of Cognitive Screening in Older Adults.
العنوان: | Agreement Between the Mini-Cog in the Preoperative Clinic and on the Day of Surgery and Association With Postanesthesia Care Unit Delirium: A Cohort Study of Cognitive Screening in Older Adults. |
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المؤلفون: | Tiwary N; From the New York Medical College School of Medicine, Valhalla, New York., Treggiari MM; Department of Anesthesiology & Perioperative Medicine, Oregon Health & Science University, Portland, Oregon.; Department of Anesthesiology, Yale University, New Haven, Connecticut., Yanez ND; Department of Anesthesiology & Perioperative Medicine, Oregon Health & Science University, Portland, Oregon.; Department of Anesthesiology, Yale University, New Haven, Connecticut., Kirsch JR; Department of Anesthesiology & Perioperative Medicine, Oregon Health & Science University, Portland, Oregon.; Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, Wisconsin., Tekkali P; Department of Anesthesiology & Perioperative Medicine, Oregon Health & Science University, Portland, Oregon., Taylor CC; Department of Internal Medicine, Portland Providence Medical Center, Portland, Oregon., Schenning KJ; Department of Anesthesiology & Perioperative Medicine, Oregon Health & Science University, Portland, Oregon. |
المصدر: | Anesthesia and analgesia [Anesth Analg] 2021 Apr 01; Vol. 132 (4), pp. 1112-1119. |
نوع المنشور: | Comparative Study; Journal Article; Research Support, Non-U.S. Gov't |
اللغة: | English |
بيانات الدورية: | Publisher: Lippincott Williams & Wilkins Country of Publication: United States NLM ID: 1310650 Publication Model: Print Cited Medium: Internet ISSN: 1526-7598 (Electronic) Linking ISSN: 00032999 NLM ISO Abbreviation: Anesth Analg Subsets: MEDLINE |
أسماء مطبوعة: | Publication: 1998- : Baltimore, Md. : Lippincott Williams & Wilkins Original Publication: Cleveland, International Anesthesia Research Society. |
مواضيع طبية MeSH: | Anesthesia Recovery Period* , Cognition* , Mental Status and Dementia Tests* , Preoperative Care*, Anesthesia, General/*adverse effects , Cognitive Dysfunction/*diagnosis , Elective Surgical Procedures/*adverse effects , Emergence Delirium/*etiology, Aged ; Aged, 80 and over ; Cognitive Dysfunction/complications ; Cognitive Dysfunction/psychology ; Emergence Delirium/diagnosis ; Emergence Delirium/psychology ; Female ; Humans ; Male ; Predictive Value of Tests ; Reproducibility of Results ; Risk Assessment ; Risk Factors ; Treatment Outcome |
مستخلص: | Background: Cognitive impairment is common in older surgical patients and is associated with postoperative delirium. However, cognitive function is inconsistently assessed preoperatively, leading to missed opportunities to recognize vulnerable patients. We designed a prospective cohort study to assess the agreement of the Mini-Cog screening tool administered in the preoperative clinic (clinic-day test) or immediately before surgery (surgery-day test) and to determine whether a positive screening for cognitive dysfunction in the surgery-day test is associated with postoperative delirium in the postanesthesia care unit (PACU). Methods: This was a cohort study of patients aged 65-89 years, scheduled for elective, inpatient surgery under general anesthesia between June 20, 2018 and August 3, 2018. Mini-Cog test scores were obtained during a clinic-day test and surgery-day test. The Short Confusion Assessment Method was performed in the PACU. Agreement between Mini-Cog clinic-day and surgery-day test scores was estimated using an ordinally weighted kappa statistic, κ. Multivariable logistic regression was used to determine whether there was an association between a positive screen for cognitive impairment and PACU delirium. Odds ratio analysis was performed to determine whether the Mini-Cog score was associated with PACU delirium. Results: Of 128 patients meeting eligibility criteria, 80 patients were enrolled. Ten had cognitive impairment based on the Mini-Cog clinic-day test score, while 70 did not. Age, sex, race, education level, subjective memory impairment, and American Society of Anesthesiologists (ASA) physical status were equivalent in the 2 groups. The mean number of days between the clinic-day score and the surgery-day score was 8.4 days (standard deviation [SD] = 6.9). Mini-Cog clinic-day and surgery-day scores had high agreement (κ = 0.78; 95% confidence interval [CI], 0.69-0.87; P < .001), and both scores were highly predictive of PACU delirium. Patients with Mini-Cog surgery-day scores compatible with cognitive impairment (Mini-Cog scores ≤2) had an estimated 12.8 times higher odds of PACU delirium compared to patients with normal cognitive function or Mini-Cog scores >2 (odds ratio [OR] = 12.8; 95% CI, 2.6-63.8, P = .002). Similarly, patients with Mini-Cog clinic-day test scores compatible with cognitive impairment had an estimated 29 times higher odds of PACU delirium compared to patients with normal cognitive function (OR = 29.0; 95% CI, 2.6-63.8, P < .001). Conclusions: These data support the approach of using the Mini-Cog on the day of surgery to screen for cognitive impairment in older patients. Importantly, Mini-Cog surgery-day test scores compatible with cognitive impairment (≤2) were strongly associated with PACU delirium. Competing Interests: The authors declare no conflicts of interest. (Copyright © 2020 International Anesthesia Research Society.) |
References: | Culley DJ, Flaherty D, Fahey MC, et al. Poor performance on a preoperative cognitive screening test predicts postoperative complications in older orthopedic surgical patients. Anesthesiology. 2017;127:765–774. Robinson TN, Raeburn CD, Tran ZV, Angles EM, Brenner LA, Moss M. Postoperative delirium in the elderly: risk factors and outcomes. Ann Surg. 2009;249:173–178. Racine AM, Fong TG, Gou Y, et al. Clinical outcomes in older surgical patients with mild cognitive impairment. Alzheimers Dement. 2018;14:590–600. Gajdos C, Kile D, Hawn MT, Finlayson E, Henderson WG, Robinson TN. The significance of preoperative impaired sensorium on surgical outcomes in nonemergent general surgical operations. JAMA Surg. 2015;150:30–36. Kim S, Brooks AK, Groban L. Preoperative assessment of the older surgical patient: honing in on geriatric syndromes. Clin Interv Aging. 2015;10:13–27. American Geriatrics Society Expert Panel on Postoperative Delirium in Older Adults. Postoperative delirium in older adults: best practice statement from the American Geriatrics Society. J Am Coll Surg. 2015;220:136–148.e131. Allen K, Ouslander JG. Age-friendly health systems: their time has come. J Am Geriatr Soc. 2018;66:19–21. Fleisher L, Peden C. ASA Perioperative brain health initiative: a call to action. ASA Monitor 4. 2018;82:36–38. Borson S. Mini-Cog. Instructions for administration & Scoring. Available at: http://mini-cog.com/wp-content/uploads/2015/12/Universal-Mini-Cog-Form-011916.pdf . Accessed February 13, 2020. Borson S, Scanlan J, Brush M, Vitaliano P, Dokmak A. The mini-cog: a cognitive ‘vital signs’ measure for dementia screening in multi-lingual elderly. Int J Geriatr Psychiatry. 2000;15:1021–1027. Steenland NK, Auman CM, Patel PM, et al. Development of a rapid screening instrument for mild cognitive impairment and undiagnosed dementia. J Alzheimers Dis. 2008;15:419–427. Culley DJ, Flaherty D, Reddy S, et al. Preoperative cognitive stratification of older elective surgical patients: a cross-sectional study. Anesth Analg. 2016;123:186–192. Tam E, Gandesbery BT, Young L, Borson S, Gorodeski EZ. Graphical instructions for administration and scoring the mini-cog: results of a randomized clinical trial. J Am Geriatr Soc. 2018;66:987–991. Inouye SK. The Short Confusion Assessment Method (Short CAM): Training Manual and Coding Guide. 2014. Boston: Hospital Elder Life Program. Available at: https://www.hospitalelderlifeprogram.org/uploads/disclaimers/Short_CAM_Training_Manual . Accessed February 13, 2020. Sessler CN, Gosnell MS, Grap MJ, et al. The Richmond Agitation-Sedation Scale: validity and reliability in adult intensive care unit patients. Am J Respir Crit Care Med. 2002;166:1338–1344. Card E, Pandharipande P, Tomes C, et al. Emergence from general anaesthesia and evolution of delirium signs in the post-anaesthesia care unit. Br J Anaesth. 2015;115:411–417. Inouye SK, van Dyck CH, Alessi CA, Balkin S, Siegal AP, Horwitz RI. Clarifying confusion: the confusion assessment method. A new method for detection of delirium. Ann Intern Med. 1990;113:941–948. Fleiss JL, Cohen J. The equivalence of weighted kappa and the intraclass correlation coefficient as measures of reliability. Educational Psychol Measurement. 1973;33:613–619. Lumley T, Diehr P, Emerson S, Chen L. The importance of the normality assumption in large public health data sets. Annu Rev Public Health. 2002;23:151–169. Murkin JM, Newman SP, Stump DA, Blumenthal JA. Statement of consensus on assessment of neurobehavioral outcomes after cardiac surgery. Ann Thorac Surg. 1995;59:1289–1295. Ritchie K. Mild cognitive impairment: an epidemiological perspective. Dialogues Clin Neurosci. 2004;6:401–408. Gauthier S, Reisberg B, Zaudig M, et al.; International Psychogeriatric Association Expert Conference on mild cognitive impairment. Mild cognitive impairment. Lancet. 2006;367:1262–1270. Berger M, Schenning KJ, Brown CH 4th, et al.; Perioperative Neurotoxicity Working Group. Best practices for postoperative brain health: recommendations from the fifth international perioperative neurotoxicity working group. Anesth Analg. 2018;127:1406–1413. Hernandez BA, Lindroth H, Rowley P, et al. Post-anaesthesia care unit delirium: incidence, risk factors and associated adverse outcomes. Br J Anaesth. 2017;119:288–290. Neufeld KJ, Leoutsakos JM, Sieber FE, et al. Outcomes of early delirium diagnosis after general anesthesia in the elderly. Anesth Analg. 2013;117:471–478. Sharma PT, Sieber FE, Zakriya KJ, et al. Recovery room delirium predicts postoperative delirium after hip-fracture repair. Anesth Analg. 2005;101:1215–1220. Xará D, Silva A, Mendonça J, Abelha F. Inadequate emergence after anesthesia: emergence delirium and hypoactive emergence in the postanesthesia care unit. J Clin Anesth. 2013;25:439–446. Veiga D, Luis C, Parente D, et al. Postoperative delirium in intensive care patients: risk factors and outcome. Rev Bras Anestesiol. 2012;62:469–483. Long LS, Shapiro WA, Leung JM. A brief review of practical preoperative cognitive screening tools. Can J Anaesth. 2012;59:798–804. |
تواريخ الأحداث: | Date Created: 20201001 Date Completed: 20210405 Latest Revision: 20230721 |
رمز التحديث: | 20231215 |
DOI: | 10.1213/ANE.0000000000005197 |
PMID: | 33002933 |
قاعدة البيانات: | MEDLINE |
تدمد: | 1526-7598 |
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DOI: | 10.1213/ANE.0000000000005197 |