Division of Geriatrics, Department of Internal Medicine, Duke University Health Systems, Durham, North Carolina.
Center for Aging, Duke University Health Systems, Durham, North Carolina.
J Am Geriatr Soc. 2018 Mar;66(3):584-589. doi: 10.1111/jgs.15261. Epub 2018 Jan 13.
To compare postoperative outcomes of individuals with and without cognitive impairment enrolled in the Perioperative Optimization of Senior Health (POSH) program at Duke University, a comanagement model involving surgery, anesthesia, and geriatrics.
Retrospective analysis of individuals enrolled in a quality improvement program.
Tertiary academic center.
Older adults undergoing surgery and referred to POSH (N = 157).
Cognitive impairment was defined as a score less than 25 out of 30 (adjusted for education) on the St. Louis University Mental Status (SLUMS) Examination. Median length of stay (LOS), mean number of postoperative complications, rates of postoperative delirium (POD, %), 30-day readmissions (%), and discharge to home (%) were compared using bivariate analysis.
Seventy percent of participants met criteria for cognitive impairment (mean SLUMS score 20.3 for those with cognitive impairment and 27.7 for those without). Participants with and without cognitive impairment did not significantly differ in demographic characteristics, number of medications (including anticholinergics and benzodiazepines), or burden of comorbidities. Participants with and without cognitive impairment had similar LOS (P = .99), cumulative number of complications (P = .70), and 30-day readmission (P = .20). POD was more common in those with cognitive impairment (31% vs 24%), but the difference was not significant (P = .34). Participants without cognitive impairment had higher rates of discharge to home (80.4% vs 65.1%, P = .05).
Older adults with and without cognitive impairment referred to the POSH program fared similarly on most postoperative outcomes. Individuals with cognitive impairment may benefit from perioperative geriatric comanagement. Questions remain regarding the validity of available measures of cognition in the preoperative period.
比较在杜克大学（Duke University）的围手术期优化老年人健康（POSH）计划中接受认知障碍评估的个体与未接受认知障碍评估的个体的术后结局。该计划为一种手术、麻醉和老年病科共管模式。
对参与质量改进计划的个体进行回顾性分析。
三级学术中心。
接受手术并转诊至 POSH 的老年人（N=157）。
认知障碍的定义为圣路易斯大学精神状态（SLUMS）检查中得分低于 30 分（根据教育程度调整）的个体，中位住院时间（LOS）、术后并发症的平均数量、术后谵妄（POD）发生率（%）、30 天再入院率（%）和出院回家率（%），采用双变量分析进行比较。
70%的参与者符合认知障碍标准（认知障碍组的 SLUMS 评分为 20.3，无认知障碍组为 27.7）。认知障碍组和无认知障碍组在人口统计学特征、药物数量（包括抗胆碱能药物和苯二氮䓬类药物）或合并症负担方面无显著差异。认知障碍组和无认知障碍组的 LOS（P=0.99）、累积并发症数量（P=0.70）和 30 天再入院率（P=0.20）无显著差异。有认知障碍的个体中 POD 更为常见（31%比 24%），但差异无统计学意义（P=0.34）。无认知障碍的个体出院回家的比例更高（80.4%比 65.1%，P=0.05）。
在大多数术后结局方面，被 POSH 计划转诊的有认知障碍和无认知障碍的老年人表现相似。认知障碍个体可能受益于围手术期老年科共管。术前现有认知评估工具的有效性仍存在疑问。
