Department of Anesthesiology, Akashi Medical Center, Akashi, Japan.
Department of Anesthesiology, Nara Medical University, Kashihara, Shijo 840, Nara, 634-8522, Japan.
J Anesth. 2023 Feb;37(1):64-71. doi: 10.1007/s00540-022-03133-9. Epub 2022 Oct 28.
Preoperative cognitive impairment is a significant factor influencing post-operative delirium. We have been performing routine pre-operative comprehensive assessments, including evaluation of cognitive function, handgrip strength, oral hygiene, and nutritional status, in patients aged ≥ 65 years since April 2021. This study aimed to examine the completion rate of pre-operative comprehensive assessment and assess the prevalence of pre-operative undiagnosed cognitive impairment.
In this prospective observational study including patients aged ≥ 65 years scheduled for elective surgery with general or regional anesthesia, cognitive impairment was defined as a Mini-Cog score ≤ 2, and its associations with handgrip strength, oral hygiene, and nutritional status were evaluated. Oral hygiene and nutritional status were assessed using an oral frailty self-checklist and the Mini Nutritional Assessment-Short Form, respectively. The incidence of pre-operative undiagnosed cognitive impairment was estimated, and its associated factors were explored with multiple logistic regression.
Among 331 eligible patients, the completion rate was 97.7% (305/312). The mean age was 74.8 years, and 13.1% (40/305) (95% confidence interval [CI], 9.7-17.3%) of the patients had pre-operative undiagnosed cognitive impairment. Multiple logistic regression revealed that handgrip strength (odds ratio [OR] = 0.94, 95%CI = 0.89-0.99) and oral frailty self-checklist score (OR = 1.19, 95%CI = 1.02-1.40) were associated with pre-operative undiagnosed cognitive impairment, while the Mini Nutritional Assessment-Short Form score was not significantly associated (OR = 0.97, 95%CI = 0.82-1.14).
Preoperative comprehensive assessment was feasible. The prevalence of pre-operative undiagnosed cognitive impairment was 13%, and poor handgrip strength and worse oral hygiene were significantly associated factors.
术前认知障碍是影响术后谵妄的一个重要因素。自 2021 年 4 月以来，我们一直在对≥65 岁的患者进行常规术前综合评估，包括认知功能、握力、口腔卫生和营养状况评估。本研究旨在检查术前综合评估的完成率，并评估术前未确诊认知障碍的患病率。
在这项包括年龄≥65 岁、接受全身或区域麻醉择期手术的患者的前瞻性观察研究中，认知障碍定义为 Mini-Cog 评分≤2，评估其与握力、口腔卫生和营养状况的关系。口腔卫生和营养状况分别采用口腔虚弱自我检查表和 Mini Nutritional Assessment-Short Form 评估。估计术前未确诊认知障碍的发生率，并通过多因素逻辑回归探讨其相关因素。
在 331 名符合条件的患者中，完成率为 97.7%（305/312）。患者平均年龄为 74.8 岁，13.1%（40/305）（95%置信区间[CI]，9.7-17.3%）的患者术前存在未确诊的认知障碍。多因素逻辑回归显示，握力（比值比[OR] = 0.94，95%CI = 0.89-0.99）和口腔虚弱自我检查表评分（OR = 1.19，95%CI = 1.02-1.40）与术前未确诊认知障碍相关，而 Mini Nutritional Assessment-Short Form 评分与术前未确诊认知障碍无显著相关性（OR = 0.97，95%CI = 0.82-1.14）。
术前综合评估是可行的。术前未确诊认知障碍的患病率为 13%，握力差和口腔卫生状况差是显著相关因素。
