Geriatric Research, Education, and Clinical Center, Boston, Massachusetts, USA.
Am J Crit Care. 2011 Mar;20(2):129-37. doi: 10.4037/ajcc2011275.
Among cardiac surgery patients, those with impaired cognitive status before surgery may have longer postoperative stays than do patients with normal status and may require additional care upon discharge.
To determine if preoperative scores on a screening measure for cognitive status (the Clock-in-the-Box), were associated with postoperative length of stay and discharge to a location other than home in patients who had cardiac surgery.
A total of 181 consecutive patients scheduled for cardiac surgery at a single site were administered the Clock-in-the-Box as part of the preoperative evaluation. Scores on the Clock-in-the-Box tool, demographic and operative information, postoperative length of stay, and discharge location were collected retrospectively from medical records.
The mean age of the patients was 68.1 years (SD, 0.7), and 99% were men. Mean postoperative length of stay was 10.5 days (SD, 8.2), and 35 patients (19%) were discharged to a facility. Scores on the Clock-in-the-Box assessment were not associated with postoperative length of stay. Increasing age, living alone before surgery, and duration of cardiopulmonary bypass were associated with discharge to a facility and were used as covariates in adjusted analyses. After adjustment, better preoperative cognitive status reduced the risk of being discharged to a facility (adjusted relative risk, 0.93; 95% confidence interval, 0.89-0.98) after cardiac surgery.
Cognitive screening before cardiac surgery can identify patients with impaired cognitive status who are less likely than patients with normal cognitive status to return home after cardiac surgery.
在心脏手术患者中，术前认知状态受损的患者术后住院时间可能长于认知状态正常的患者，并且出院后可能需要额外的护理。
确定术前认知状态筛查量表（时钟测试）的评分是否与心脏手术后患者的术后住院时间和出院去向有关。
在一个地点接受心脏手术的 181 例连续患者作为术前评估的一部分接受了时钟测试。从病历中回顾性收集时钟测试工具的分数、人口统计学和手术信息、术后住院时间和出院地点。
患者的平均年龄为 68.1 岁（标准差，0.7），99%为男性。平均术后住院时间为 10.5 天（标准差，8.2），35 名患者（19%）出院到医疗机构。时钟测试评估的分数与术后住院时间无关。年龄增长、术前独居以及心肺转流时间与出院到医疗机构有关，并在调整分析中作为协变量。调整后，术前认知状态较好降低了心脏手术后出院到医疗机构的风险（调整后的相对风险，0.93；95%置信区间，0.89-0.98）。
心脏手术前的认知筛查可以识别认知状态受损的患者，这些患者在心脏手术后比认知状态正常的患者更不可能回家。
