Department of Anesthesiology and Pain Medicine, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada.
Department of Anesthesia & Perioperative Medicine, Western University, London, ON, Canada.
J Clin Anesth. 2022 Feb;76:110574. doi: 10.1016/j.jclinane.2021.110574. Epub 2021 Nov 5.
Older surgical patients with cognitive impairment are at an increased risk for adverse perioperative outcomes, however the prevalence of preoperative cognitive impairment is not well-established within this population. The purpose of this review is to determine the pooled prevalence of preoperative cognitive impairment in older surgical patients.
Systematic review and meta-analysis.
MEDLINE (Ovid), PubMed (non-MEDLINE records only), Embase, Cochrane Central, Cochrane Database of Systematic Reviews, PsycINFO, and EMCare Nursing for relevant articles from 1946 to April 2021.
Patients aged ≥60 years old undergoing surgery, and preoperative cognitive impairment assessed by validated cognitive assessment tools.
Preoperative assessment.
Primary outcomes were the pooled prevalence of preoperative cognitive impairment in older patients undergoing either elective (cardiac or non-cardiac) or emergency surgery.
Forty-eight studies (n = 42,498) were included. In elective non-cardiac surgeries, the pooled prevalence of unrecognized cognitive impairment was 37.0% (95% confidence interval [CI]: 30.0%, 45.0%) among 27,845 patients and diagnosed cognitive impairment was 18.0% (95% CI: 9.0%, 33.0%) among 11,676 patients. Within the elective non-cardiac surgery category, elective orthopedic surgery was analyzed. In this subcategory, the pooled prevalence of unrecognized cognitive impairment was 37.0% (95% CI: 26.0%, 49.0%) among 1117 patients, and diagnosed cognitive impairment was 17.0% (95% CI: 3.0%, 60.0%) among 6871 patients. In cardiac surgeries, the unrecognized cognitive impairment prevalence across 588 patients was 26.0% (95% CI: 15.0%, 42.0%). In emergency surgeries, the unrecognized cognitive impairment prevalence was 50.0% (95% CI: 35.0%, 65.0%) among 2389 patients.
A substantial number of surgical patients had unrecognized cognitive impairment. In elective non-cardiac and emergency surgeries, the pooled prevalence of unrecognized cognitive impairment was 37.0% and 50.0%. Preoperative cognitive screening warrants more attention for risk assessment and stratification.
认知障碍的老年手术患者围手术期不良结局的风险增加，然而，该人群中术前认知障碍的患病率尚未明确。本综述的目的是确定老年手术患者术前认知障碍的患病率。
系统回顾和荟萃分析。
MEDLINE（Ovid）、PubMed（非 MEDLINE 记录）、Embase、Cochrane 中心、Cochrane 系统评价数据库、PsycINFO 和 EMCare Nursing，从 1946 年到 2021 年 4 月搜索相关文章。
年龄≥60 岁接受手术的患者，术前使用经过验证的认知评估工具评估认知障碍。
术前评估。
纳入 48 项研究（n=42498 例）。在择期非心脏手术中，27845 例患者中未识别的认知障碍患病率为 37.0%（95%可信区间：30.0%，45.0%），11676 例患者中诊断为认知障碍的患病率为 18.0%（95%可信区间：9.0%，33.0%）。在择期非心脏手术类别中，分析了择期骨科手术。在此亚组中，1117 例患者中未识别的认知障碍患病率为 37.0%（95%可信区间：26.0%，49.0%），6871 例患者中诊断为认知障碍的患病率为 17.0%（95%可信区间：3.0%，60.0%）。心脏手术中，588 例患者的未识别认知障碍患病率为 26.0%（95%可信区间：15.0%，42.0%）。在急诊手术中，2389 例患者中未识别的认知障碍患病率为 50.0%（95%可信区间：35.0%，65.0%）。
相当数量的手术患者存在未被识别的认知障碍。在择期非心脏手术和急诊手术中，未被识别的认知障碍患病率分别为 37.0%和 50.0%。术前认知筛查需要更多地关注风险评估和分层。
