Preoperative Cognitive Screening in Elderly Surgical Patients: Feasibility and Utility for Predicting Morbidity

老年手术患者的术前认知筛查：预测发病率的可行性和实用性

• 批准号: 9117357
• 负责人: DEBORAH J CULLEY
• 金额: $ 26.56万
• 依托单位: BRIGHAM AND WOMEN'S HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-08-01 至 2017-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9117357
• 关键词: Accounting; Address; Age-Years; Alzheimer' s Disease; Assessment tool; Brain; Caring; Cerebrum; Clinic; Clinical; Cognition; Cognitive; Community Surveys; Data; Delirium; Dementia; Destinations; Diagnosis; Disease; Documentation; Elderly; Evaluation; Failure; Family Physicians; Glare; Goals; Health; Healthcare Systems; Heart; Heart failure; Hospitals; Impaired cognition; Impairment; Intervention; Kidney; Length of Stay; Lower Extremity; Lung; Medical; Medical Records; Memory; Mental Health; Morbidity - disease rate; Observational Study; Operative Surgical Procedures; Organ; Outcome; Patient risk; Patients; Perioperative complication; Pharmaceutical Preparations; Pilot Projects; Population; Postoperative Period; Preparation; Principal Investigator; Procedures; Quality of life; Repeat Surgery; Replacement Arthroplasty; Reporting; Resources; Risk; Stress; Structure; Support System; Surgeon; Surgical complication; Surveys; Testing; Thinking; Time; Visit; Woman; Work; adverse outcome; age group; base; clinical practice; cognitive function; confusion assessment method; cost; experience; family support; functional outcomes; high risk; hip replacement arthroplasty; improved; individual patient; informant; innovation; instrument; interest; knee replacement arthroplasty; mild cognitive impairment; mortality; older patient; patient oriented; physical conditioning; postoperative delirium; programs; prospective; response; screening; secondary outcome; tool

 DESCRIPTION (provided by applicant): Approximately 1 in 3 surgical procedures nationally is performed on a patient = 65 years of age. These geriatric surgical patients have a high rate of perioperative complications and often do poorly, so there is intense interest in identifying predictors of adverse outcomes in this age group. Although preoperative assessment of major vital organs has been a routine part of preparation for surgery for decades, brain function is typically not evaluated. We propose that preexisting cognitive impairment is a strong predictor of poor medical-surgical and functional outcomes and that preoperative cognitive screening could identify those at risk. In a pilot study using the MiniCog, a brief, validated, structured cognitiv screening tool with high inter-rater reliability and patient acceptance, we found that 20-33% of older elective geriatric surgical patients are likely to be cognitively impaired preoperatively, findings consistent with community surveys of older adults. The goals of this proposal are to demonstrate that there is marginal benefit to preoperative cognitive screening for identifying cognitively impaired seniors (Aim 1) and that preoperative cognitive impairment predicts the risk of postoperative medical- surgical complications and poor functional outcomes (Aim 2). To this end, we will conduct a prospective observational study in which the MiniCog will be administered in the Center for Preoperative Evaluation at Brigham & Women's Hospital (Preop Center) to cognitively screen 250 patients = 65 years of age during the routine preoperative visit prior to elective total knee or hip replacement surgery. These surgical procedures are selected because they are common in this age group, reasonably uniform procedurally, and the underlying disease has no association beyond that of advancing age with cognitive function. Aim 1 will test the hypothesis that systematic chart review and patient/informant report of seeking medical advice about cognition/memory will improve the sensitivity of the standard preop evaluation but that many cases of likely impairment, and even severe impairment, based on MiniCog scores will go undetected without structured screening. In Aim 2 we will test the hypothesis that poor preoperative cognitive function as assessed by the MiniCog predicts medical- surgical complications and poor functional outcomes, with delirium and suboptimal change in the SF36 as the primary endpoints, respectively. We anticipate preoperative cognitive screening of seniors will prove to be better than current standard or systematic clinical practices for identifying patients with evidence of likely cognitive impairment and that evidence of such wil predict a poor outcome. The work has the potential for high clinical impact and is innovative because it brings together a cross disciplinary group to address new and important questions about the effect of cognition on surgical outcomes in seniors in a practical way that could transform the way we think about, evaluate, and manage the elderly brain and patient in a surgical setting.

 描述（由适用提供）：全国大约有1分三分之一的手术程序是对= 65岁的患者进行的。这些老年外科手术患者的周期性并发症发生率很高，而且通常情况差，因此在确定该年龄段的不良后果预测因素方面非常感兴趣。尽管对主要重要器官的术前评估数十年来一直是手术准备的常规部分，但通常未评估大脑功能。我们建议先前存在的认知障碍是医学手术和功能性结果不良的有力预测指标，术前认知筛查可以识别有危险的认知筛查。在一项使用Minicog的试点研究中，具有高评分者间可靠性和患者接受的简短，经过验证的结构化认知筛查工具，我们发现20-33％的老年人选修老年人外科手术患者可能会在术前认知受损，从而与老年人的社区调查一致。该提案的目标是证明术前认知筛查具有边缘好处，以识别认知障碍的老年人（AIM 1），并且术前认知障碍预测了术后医学性手术并发症的风险和功能不良的风险（AIM 2）。为此，我们将进行一项前瞻性观察性研究，其中将在Brigham＆妇女医院（Preop Center）的术前评估中心进行小型摄体，以认知筛查250名患者= 65岁的患者在选举术前术前术前访问期间占65岁。之所以选择这些手术程序，是因为它们在这个年龄组中很常见，在程序上相当均匀，并且潜在的疾病与认知功能的年龄相比没有任何关联。 AIM 1将检验以下假设：有关认知/记忆的医疗建议的系统图表审查和患者/线人的报告将提高标准的PREOP评估的敏感性，但是许多可能的损害案例，甚至基于微型摩擦分数的严重损害的案例也将在没有结构性筛选的情况下进行。在AIM 2中，我们将检验以下假设：由小型摩断生物群评估的术前认知功能较差，可以预测医学手术并发症和功能性不佳的结果，而SF36分别是主要终点，而SF36的del妄和次优变。我们预计老年人的术前认知筛查将比当前的标准或系统临床实践更好 为了确定具有认知障碍的证据的患者，并且这种WIL的证据预示了不良结果。这项工作有可能产生高临床影响，并且具有创新性，因为它汇集了一个跨学科群体，以解决有关认知对老年人手术结果的新的重要问题，其实用方式可以改变我们在外科手术环境中思考，评估和管理老年人的大脑和患者的方式。

项目成果

Brief Preoperative Screening for Frailty and Cognitive Impairment Predicts Delirium after Spine Surgery.

• DOI: 10.1097/aln.0000000000003523
• 发表时间: 2020-12-01
• 期刊: Anesthesiology
• 影响因子: 8.8
• 作者: Susano MJ;Grasfield RH;Friese M;Rosner B;Crosby G;Bader AM;Kang JD;Smith TR;Lu Y;Groff MW;Chi JH;Grodstein F;Culley DJ
• 通讯作者: Culley DJ