Relevance of Preoperative Cognitive Impairment for Predicting Postoperative Delirium in Surgical Medicine: A Prospective Cohort Study
Background: Post-operative delirium is a dreaded complication after surgery in older patients. The identification of risk factors for delirium and comprehensive geriatric assessment is an extensive part of recent research. However, the preoperative assessment of risk factors, such as impaired cognit...
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MDPI AG
2024-12-01
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| author | Henriette Louise Moellmann Eman Alhammadi Philipp Olbrich Helmut Frohnhofen |
| author_facet | Henriette Louise Moellmann Eman Alhammadi Philipp Olbrich Helmut Frohnhofen |
| author_sort | Henriette Louise Moellmann |
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| description | Background: Post-operative delirium is a dreaded complication after surgery in older patients. The identification of risk factors for delirium and comprehensive geriatric assessment is an extensive part of recent research. However, the preoperative assessment of risk factors, such as impaired cognition, is frequently not standardized. Methods: A comprehensive preoperative assessment was performed in 421 surgical patients to investigate the impact of preoperative cognitive impairment (PCI) on the risk of delirium and to evaluate appropriate screening tools (Six-item screener (SIS) and clock-drawing test (CDT)). Results: Both screening tools showed a significantly increased risk of delirium with <i>p</i> < 0.001 (OR 12.5, 95% [6.42; 24.4]) in SIS and <i>p</i> = 0.042 (OR 2.02, 95%CI [1.02; 4.03]) in CDT for existing cognitive impairment. A higher level of care (<i>p</i> < 0.001) and statutory care (<i>p</i> < 0.001, OR 5.42, 95%CI [2.34; 12.6]) also proved to be significant risk factors. The ROC curves of the two tests show AUC values of 0.741 (SIS) and 0.630 (CDT). The COP values for the SIS are 4 points with a Youden index of 0.447; for the CDT, the COP is 2 (Youden index = 0.177). Conclusions: The recording of PCI should be a central component of the preoperative geriatric assessment. The tools used are simple yet effective and can be easily implemented in routine clinical practice. By reliably identifying patients at risk, the available resources can be personalized and used in a targeted approach. |
| format | Article |
| id | doaj-art-e4734d1ce00f45fba98af90a44aedaa7 |
| institution | Kabale University |
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| language | English |
| publishDate | 2024-12-01 |
| publisher | MDPI AG |
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| series | Geriatrics |
| spelling | doaj-art-e4734d1ce00f45fba98af90a44aedaa72024-12-27T14:28:28ZengMDPI AGGeriatrics2308-34172024-12-019615510.3390/geriatrics9060155Relevance of Preoperative Cognitive Impairment for Predicting Postoperative Delirium in Surgical Medicine: A Prospective Cohort StudyHenriette Louise Moellmann0Eman Alhammadi1Philipp Olbrich2Helmut Frohnhofen3Cranio-and-Maxillo Facial Surgery, University Hospital Düsseldorf, Moorenstraße 5, 40225 Düsseldorf, GermanyCranio-and-Maxillo Facial Surgery, University Hospital Düsseldorf, Moorenstraße 5, 40225 Düsseldorf, GermanyMedical Faculty, Heinrich-Heine-Universität Düsseldorf, Universitätsstrasse 1, 40225 Düsseldorf, GermanyOrthopedics and Trauma Surgery, University Hospital Düsseldorf, Moorenstraße 5, 40225 Düsseldorf, GermanyBackground: Post-operative delirium is a dreaded complication after surgery in older patients. The identification of risk factors for delirium and comprehensive geriatric assessment is an extensive part of recent research. However, the preoperative assessment of risk factors, such as impaired cognition, is frequently not standardized. Methods: A comprehensive preoperative assessment was performed in 421 surgical patients to investigate the impact of preoperative cognitive impairment (PCI) on the risk of delirium and to evaluate appropriate screening tools (Six-item screener (SIS) and clock-drawing test (CDT)). Results: Both screening tools showed a significantly increased risk of delirium with <i>p</i> < 0.001 (OR 12.5, 95% [6.42; 24.4]) in SIS and <i>p</i> = 0.042 (OR 2.02, 95%CI [1.02; 4.03]) in CDT for existing cognitive impairment. A higher level of care (<i>p</i> < 0.001) and statutory care (<i>p</i> < 0.001, OR 5.42, 95%CI [2.34; 12.6]) also proved to be significant risk factors. The ROC curves of the two tests show AUC values of 0.741 (SIS) and 0.630 (CDT). The COP values for the SIS are 4 points with a Youden index of 0.447; for the CDT, the COP is 2 (Youden index = 0.177). Conclusions: The recording of PCI should be a central component of the preoperative geriatric assessment. The tools used are simple yet effective and can be easily implemented in routine clinical practice. By reliably identifying patients at risk, the available resources can be personalized and used in a targeted approach.https://www.mdpi.com/2308-3417/9/6/155postoperative deliriumsurgerycognitive impairmentgeriatric assessment |
| spellingShingle | Henriette Louise Moellmann Eman Alhammadi Philipp Olbrich Helmut Frohnhofen Relevance of Preoperative Cognitive Impairment for Predicting Postoperative Delirium in Surgical Medicine: A Prospective Cohort Study Geriatrics postoperative delirium surgery cognitive impairment geriatric assessment |
| title | Relevance of Preoperative Cognitive Impairment for Predicting Postoperative Delirium in Surgical Medicine: A Prospective Cohort Study |
| title_full | Relevance of Preoperative Cognitive Impairment for Predicting Postoperative Delirium in Surgical Medicine: A Prospective Cohort Study |
| title_fullStr | Relevance of Preoperative Cognitive Impairment for Predicting Postoperative Delirium in Surgical Medicine: A Prospective Cohort Study |
| title_full_unstemmed | Relevance of Preoperative Cognitive Impairment for Predicting Postoperative Delirium in Surgical Medicine: A Prospective Cohort Study |
| title_short | Relevance of Preoperative Cognitive Impairment for Predicting Postoperative Delirium in Surgical Medicine: A Prospective Cohort Study |
| title_sort | relevance of preoperative cognitive impairment for predicting postoperative delirium in surgical medicine a prospective cohort study |
| topic | postoperative delirium surgery cognitive impairment geriatric assessment |
| url | https://www.mdpi.com/2308-3417/9/6/155 |
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