Abess Alexander T, Shah Nirav J, Whitlock Elizabeth L, Schroeck Hedwig, Ron Donna, Rozek Sandra Becker, Martinez-Camblor Pablo, Donovan Anne L, Schenning Katie J, Deiner Stacie G
From the Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire.
Department of Anesthesiology and Perioperative Medicine, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire.
Anesth Analg. 2025 Nov 1;141(5):1097-1106. doi: 10.1213/ANE.0000000000007557. Epub 2025 May 16.
Guidelines recommend routine screening perioperatively for cognitive impairment, frailty, and delirium for patients at risk. Capturing these 3 geriatric screening variables in multicenter databases would also enable much-needed large-scale pragmatic research. Our primary hypothesis was that the well-curated Multicenter Perioperative Outcomes Group (MPOG) database would have a low rate of retrievable geriatric screening variables. Our secondary hypothesis was that multiple barriers exist that impede clinical implementation of recommended screenings as well as the digital capture of these variables into the MPOG database.
This was a 2-component study. The first component was a retrospective observational analysis using the MPOG database to identify geriatric screening variables in patients over the age of 65 undergoing nonemergent inpatient surgery. The second component was a survey sent to MPOG participant sites (49 institutions) to assess actual screening practices and perspectives.
Of the 908,158 relevant patient records only 8054 (0.89%) were identified as having a preoperative cognitive screen, and 123,114 (13.6%) were identified as having a postoperative delirium screening. No frailty screenings were observed. Forty-3 survey responses (88% response rate) were received. Approximately half of the respondents indicated their institutions perform cognitive screening (n=22; 51.2%), frailty screening (n=17; 44.7%), or delirium screening (n = 16; 45.7%). Only 10 institutions (23.2%) reported performing all 3, and 13 (30.2%) institutions reported performing none. Multiple barriers were identified. The most common significant barrier reported was a lack of available standard screening tools for the electronic health record.
This study identified minimal data collection related to neurocognitive disorders which appears incongruous with clinical practice guidelines. Challenges related to capturing this data locally and in multi-center datasets were identified. Overcoming those barriers may facilitate future pragmatic research studies related to this important public health priority.
指南建议对有风险的患者在围手术期进行认知障碍、衰弱和谵妄的常规筛查。在多中心数据库中获取这三个老年筛查变量将有助于开展急需的大规模实用研究。我们的主要假设是，精心整理的多中心围手术期结果组（MPOG）数据库中可检索的老年筛查变量率较低。我们的次要假设是，存在多种障碍阻碍了推荐筛查的临床实施以及将这些变量数字化录入MPOG数据库。
这是一项由两部分组成的研究。第一部分是一项回顾性观察分析，使用MPOG数据库识别65岁以上接受非急诊住院手术患者的老年筛查变量。第二部分是向MPOG参与站点（49个机构）发送的一项调查，以评估实际筛查做法和观点。
在908158份相关患者记录中，只有8054份（0.89%）被确定进行了术前认知筛查，123114份（13.6%）被确定进行了术后谵妄筛查。未观察到衰弱筛查。收到了43份调查回复（回复率88%）。大约一半的受访者表示其机构进行认知筛查（n=22；51.2%）、衰弱筛查（n=17；44.7%）或谵妄筛查（n = 16；45.7%）。只有10个机构（23.2%）报告进行了所有三项筛查，13个机构（30.2%）报告一项都未进行。确定了多种障碍。报告的最常见的重大障碍是电子健康记录缺乏可用的标准筛查工具。
本研究发现与神经认知障碍相关的数据收集极少，这似乎与临床实践指南不一致。确定了在本地和多中心数据集中获取这些数据的挑战。克服这些障碍可能有助于未来开展与这一重要公共卫生重点相关的实用研究。
