Association Among Preoperative Cognitive Performance, Regional Cerebral Oxygen Saturation, and Postoperative Delirium in Older Portuguese Patients
BACKGROUND:Postoperative delirium is common among older patients and preoperative identification of high-risk patients is widely recommended. The aim of this study was to assess whether preoperative cognitive performance using brief screening tools or regional cerebral oxygen saturation (SctO2) was...
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| Veröffentlicht in: | Anesthesia and analgesia 2021-03, Vol.132 (3), p.846-855 |
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| creator | Susano, Maria J. Dias, Mariana Seixas, Francisco S. Vide, Sérgio Grasfield, Rachel Abelha, Fernando J. Crosby, Gregory Culley, Deborah J. Amorim, Pedro |
| description | BACKGROUND:Postoperative delirium is common among older patients and preoperative identification of high-risk patients is widely recommended. The aim of this study was to assess whether preoperative cognitive performance using brief screening tools or regional cerebral oxygen saturation (SctO2) was associated with the development of postoperative delirium in older Portuguese patients undergoing elective surgery.
METHODS:Prospective observational cohort study where preoperative cognitive screening tools (Mini-Cog, Mini-Mental State Examination, verbal fluency) and SctO2 (INVOS 5100C; Medtronic, Ireland) were assessed in 238 patients ≥65 years old undergoing elective surgery between July 2017 and May 2019 at a tertiary academic center in Portugal. The primary outcome was postoperative delirium detected by the 3D-Confusion Assessment Method. Data were analyzed by univariate analysis and multivariable logistic regression.
RESULTS:Delirium was identified in 53 patients (22%); 162 patients (68%) had completed only 4 years of education. On multivariable analysis, probable cognitive impairment tested by the Mini-Cog (odds ratio [OR] = 1.57; 95% confidence interval [CI], 0.70–3.53; corrected P value >.999), by the Mini-Mental State Examination (OR = 2.75; 95% CI, 1.23–6.13; corrected P value = .052), and by the animal verbal fluency test (OR = 1.24; 95% CI, 0.49–3.16; corrected P value >.999) were not significantly associated with the development of postoperative delirium. In contrast, lower preoperative SctO2 (OR = 1.08; 95% CI, 1.02–1.14; corrected P value = .024 for each point decrease in SctO2) was associated with postoperative delirium.
CONCLUSIONS:We did not find enough evidence to suggest that poor preoperative cognitive performance was significantly associated with the development of postoperative delirium in an older Portuguese surgical population with an overall low level of formal education, but rather that preoperative SctO2 may be helpful in identifying patients at risk for delirium. |
| doi_str_mv | 10.1213/ANE.0000000000005159 |
| format | Article |
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METHODS:Prospective observational cohort study where preoperative cognitive screening tools (Mini-Cog, Mini-Mental State Examination, verbal fluency) and SctO2 (INVOS 5100C; Medtronic, Ireland) were assessed in 238 patients ≥65 years old undergoing elective surgery between July 2017 and May 2019 at a tertiary academic center in Portugal. The primary outcome was postoperative delirium detected by the 3D-Confusion Assessment Method. Data were analyzed by univariate analysis and multivariable logistic regression.
RESULTS:Delirium was identified in 53 patients (22%); 162 patients (68%) had completed only 4 years of education. On multivariable analysis, probable cognitive impairment tested by the Mini-Cog (odds ratio [OR] = 1.57; 95% confidence interval [CI], 0.70–3.53; corrected P value >.999), by the Mini-Mental State Examination (OR = 2.75; 95% CI, 1.23–6.13; corrected P value = .052), and by the animal verbal fluency test (OR = 1.24; 95% CI, 0.49–3.16; corrected P value >.999) were not significantly associated with the development of postoperative delirium. In contrast, lower preoperative SctO2 (OR = 1.08; 95% CI, 1.02–1.14; corrected P value = .024 for each point decrease in SctO2) was associated with postoperative delirium.
CONCLUSIONS:We did not find enough evidence to suggest that poor preoperative cognitive performance was significantly associated with the development of postoperative delirium in an older Portuguese surgical population with an overall low level of formal education, but rather that preoperative SctO2 may be helpful in identifying patients at risk for delirium.</description><identifier>ISSN: 0003-2999</identifier><identifier>EISSN: 1526-7598</identifier><identifier>DOI: 10.1213/ANE.0000000000005159</identifier><identifier>PMID: 33002925</identifier><language>eng</language><publisher>United States: Lippincott Williams & Wilkin</publisher><subject>Age Factors ; Aged ; Aged, 80 and over ; Blood Gas Monitoring, Transcutaneous ; Cerebrovascular Circulation ; Cognition ; Cognitive Dysfunction - complications ; Cognitive Dysfunction - diagnosis ; Cognitive Dysfunction - psychology ; Delirium - diagnosis ; Delirium - etiology ; Delirium - psychology ; Elective Surgical Procedures - adverse effects ; Female ; Humans ; Male ; Neuropsychological Tests ; Oxygen - blood ; Portugal ; Postoperative Complications - diagnosis ; Postoperative Complications - etiology ; Postoperative Complications - psychology ; Prospective Studies ; Risk Assessment ; Risk Factors ; Spectroscopy, Near-Infrared ; Treatment Outcome</subject><ispartof>Anesthesia and analgesia, 2021-03, Vol.132 (3), p.846-855</ispartof><rights>Lippincott Williams & Wilkin</rights><rights>2020 International Anesthesia Research Society</rights><rights>Copyright © 2020 International Anesthesia Research Society.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4679-c59af22bb2d098bfb49cb0964aba2ab2e1416c2f13a2a364a3110540162744793</citedby><cites>FETCH-LOGICAL-c4679-c59af22bb2d098bfb49cb0964aba2ab2e1416c2f13a2a364a3110540162744793</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttp://ovidsp.ovid.com/ovidweb.cgi?T=JS&NEWS=n&CSC=Y&PAGE=fulltext&D=ovft&AN=00000539-202103000-00033$$EHTML$$P50$$Gwolterskluwer$$H</linktohtml><link.rule.ids>314,776,780,4594,27903,27904,65209</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33002925$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Susano, Maria J.</creatorcontrib><creatorcontrib>Dias, Mariana</creatorcontrib><creatorcontrib>Seixas, Francisco S.</creatorcontrib><creatorcontrib>Vide, Sérgio</creatorcontrib><creatorcontrib>Grasfield, Rachel</creatorcontrib><creatorcontrib>Abelha, Fernando J.</creatorcontrib><creatorcontrib>Crosby, Gregory</creatorcontrib><creatorcontrib>Culley, Deborah J.</creatorcontrib><creatorcontrib>Amorim, Pedro</creatorcontrib><title>Association Among Preoperative Cognitive Performance, Regional Cerebral Oxygen Saturation, and Postoperative Delirium in Older Portuguese Patients</title><title>Anesthesia and analgesia</title><addtitle>Anesth Analg</addtitle><description>BACKGROUND:Postoperative delirium is common among older patients and preoperative identification of high-risk patients is widely recommended. The aim of this study was to assess whether preoperative cognitive performance using brief screening tools or regional cerebral oxygen saturation (SctO2) was associated with the development of postoperative delirium in older Portuguese patients undergoing elective surgery.
METHODS:Prospective observational cohort study where preoperative cognitive screening tools (Mini-Cog, Mini-Mental State Examination, verbal fluency) and SctO2 (INVOS 5100C; Medtronic, Ireland) were assessed in 238 patients ≥65 years old undergoing elective surgery between July 2017 and May 2019 at a tertiary academic center in Portugal. The primary outcome was postoperative delirium detected by the 3D-Confusion Assessment Method. Data were analyzed by univariate analysis and multivariable logistic regression.
RESULTS:Delirium was identified in 53 patients (22%); 162 patients (68%) had completed only 4 years of education. On multivariable analysis, probable cognitive impairment tested by the Mini-Cog (odds ratio [OR] = 1.57; 95% confidence interval [CI], 0.70–3.53; corrected P value >.999), by the Mini-Mental State Examination (OR = 2.75; 95% CI, 1.23–6.13; corrected P value = .052), and by the animal verbal fluency test (OR = 1.24; 95% CI, 0.49–3.16; corrected P value >.999) were not significantly associated with the development of postoperative delirium. In contrast, lower preoperative SctO2 (OR = 1.08; 95% CI, 1.02–1.14; corrected P value = .024 for each point decrease in SctO2) was associated with postoperative delirium.
CONCLUSIONS:We did not find enough evidence to suggest that poor preoperative cognitive performance was significantly associated with the development of postoperative delirium in an older Portuguese surgical population with an overall low level of formal education, but rather that preoperative SctO2 may be helpful in identifying patients at risk for delirium.</description><subject>Age Factors</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Blood Gas Monitoring, Transcutaneous</subject><subject>Cerebrovascular Circulation</subject><subject>Cognition</subject><subject>Cognitive Dysfunction - complications</subject><subject>Cognitive Dysfunction - diagnosis</subject><subject>Cognitive Dysfunction - psychology</subject><subject>Delirium - diagnosis</subject><subject>Delirium - etiology</subject><subject>Delirium - psychology</subject><subject>Elective Surgical Procedures - adverse effects</subject><subject>Female</subject><subject>Humans</subject><subject>Male</subject><subject>Neuropsychological Tests</subject><subject>Oxygen - blood</subject><subject>Portugal</subject><subject>Postoperative Complications - diagnosis</subject><subject>Postoperative Complications - etiology</subject><subject>Postoperative Complications - psychology</subject><subject>Prospective Studies</subject><subject>Risk Assessment</subject><subject>Risk Factors</subject><subject>Spectroscopy, Near-Infrared</subject><subject>Treatment Outcome</subject><issn>0003-2999</issn><issn>1526-7598</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFUttu1DAQtRCILoU_QMiPPDTFt2Tjx9W2XKSKXXF5juzsJA049jJOKP0Nvphpt1zEA_jFM8fnnBnNmLGnUpxKJfWL1dvzU_HHKWVp77GFLFVVLEtb32cLQnWhrLVH7FHOnyiVoq4esiOthVBWlQv2fZVzagc3DSny1Zhiz7cIaQ9I0Ffg69TH4TbaAnYJRxdbOOHvoCeBC3wNCB4p2Hy77iHy926a8dbthLu449uUp99uZxAGHOaRD5Fvwg6Q3nGa-xkyFSAOxCk_Zg86FzI8ubuP2ceX5x_Wr4uLzas369VF0ZpqaYu2tK5Tynu1E7b2nTe29cJWxnmnnFcgjaxa1UlNqSZYSylKI2SllsYsrT5mzw--e0xfqIOpGYfcQgguQppzo4ypDY3a1EQ1B2qLKWeErtnjMDq8bqRobrbR0Daav7dBsmd3FWY_wu6X6Of4iVAfCFcpTID5c5ivAJtLcGG6_J-3-Yf0wNO2UEJJQeVEcfMZtP4BjIuntg</recordid><startdate>20210301</startdate><enddate>20210301</enddate><creator>Susano, Maria J.</creator><creator>Dias, Mariana</creator><creator>Seixas, Francisco S.</creator><creator>Vide, Sérgio</creator><creator>Grasfield, Rachel</creator><creator>Abelha, Fernando J.</creator><creator>Crosby, Gregory</creator><creator>Culley, Deborah J.</creator><creator>Amorim, Pedro</creator><general>Lippincott Williams & Wilkin</general><general>International Anesthesia Research Society</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20210301</creationdate><title>Association Among Preoperative Cognitive Performance, Regional Cerebral Oxygen Saturation, and Postoperative Delirium in Older Portuguese Patients</title><author>Susano, Maria J. ; Dias, Mariana ; Seixas, Francisco S. ; Vide, Sérgio ; Grasfield, Rachel ; Abelha, Fernando J. ; Crosby, Gregory ; Culley, Deborah J. ; Amorim, Pedro</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4679-c59af22bb2d098bfb49cb0964aba2ab2e1416c2f13a2a364a3110540162744793</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Age Factors</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Blood Gas Monitoring, Transcutaneous</topic><topic>Cerebrovascular Circulation</topic><topic>Cognition</topic><topic>Cognitive Dysfunction - complications</topic><topic>Cognitive Dysfunction - diagnosis</topic><topic>Cognitive Dysfunction - psychology</topic><topic>Delirium - diagnosis</topic><topic>Delirium - etiology</topic><topic>Delirium - psychology</topic><topic>Elective Surgical Procedures - adverse effects</topic><topic>Female</topic><topic>Humans</topic><topic>Male</topic><topic>Neuropsychological Tests</topic><topic>Oxygen - blood</topic><topic>Portugal</topic><topic>Postoperative Complications - diagnosis</topic><topic>Postoperative Complications - etiology</topic><topic>Postoperative Complications - psychology</topic><topic>Prospective Studies</topic><topic>Risk Assessment</topic><topic>Risk Factors</topic><topic>Spectroscopy, Near-Infrared</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Susano, Maria J.</creatorcontrib><creatorcontrib>Dias, Mariana</creatorcontrib><creatorcontrib>Seixas, Francisco S.</creatorcontrib><creatorcontrib>Vide, Sérgio</creatorcontrib><creatorcontrib>Grasfield, Rachel</creatorcontrib><creatorcontrib>Abelha, Fernando J.</creatorcontrib><creatorcontrib>Crosby, Gregory</creatorcontrib><creatorcontrib>Culley, Deborah J.</creatorcontrib><creatorcontrib>Amorim, Pedro</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Anesthesia and analgesia</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Susano, Maria J.</au><au>Dias, Mariana</au><au>Seixas, Francisco S.</au><au>Vide, Sérgio</au><au>Grasfield, Rachel</au><au>Abelha, Fernando J.</au><au>Crosby, Gregory</au><au>Culley, Deborah J.</au><au>Amorim, Pedro</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Association Among Preoperative Cognitive Performance, Regional Cerebral Oxygen Saturation, and Postoperative Delirium in Older Portuguese Patients</atitle><jtitle>Anesthesia and analgesia</jtitle><addtitle>Anesth Analg</addtitle><date>2021-03-01</date><risdate>2021</risdate><volume>132</volume><issue>3</issue><spage>846</spage><epage>855</epage><pages>846-855</pages><issn>0003-2999</issn><eissn>1526-7598</eissn><abstract>BACKGROUND:Postoperative delirium is common among older patients and preoperative identification of high-risk patients is widely recommended. The aim of this study was to assess whether preoperative cognitive performance using brief screening tools or regional cerebral oxygen saturation (SctO2) was associated with the development of postoperative delirium in older Portuguese patients undergoing elective surgery.
METHODS:Prospective observational cohort study where preoperative cognitive screening tools (Mini-Cog, Mini-Mental State Examination, verbal fluency) and SctO2 (INVOS 5100C; Medtronic, Ireland) were assessed in 238 patients ≥65 years old undergoing elective surgery between July 2017 and May 2019 at a tertiary academic center in Portugal. The primary outcome was postoperative delirium detected by the 3D-Confusion Assessment Method. Data were analyzed by univariate analysis and multivariable logistic regression.
RESULTS:Delirium was identified in 53 patients (22%); 162 patients (68%) had completed only 4 years of education. On multivariable analysis, probable cognitive impairment tested by the Mini-Cog (odds ratio [OR] = 1.57; 95% confidence interval [CI], 0.70–3.53; corrected P value >.999), by the Mini-Mental State Examination (OR = 2.75; 95% CI, 1.23–6.13; corrected P value = .052), and by the animal verbal fluency test (OR = 1.24; 95% CI, 0.49–3.16; corrected P value >.999) were not significantly associated with the development of postoperative delirium. In contrast, lower preoperative SctO2 (OR = 1.08; 95% CI, 1.02–1.14; corrected P value = .024 for each point decrease in SctO2) was associated with postoperative delirium.
CONCLUSIONS:We did not find enough evidence to suggest that poor preoperative cognitive performance was significantly associated with the development of postoperative delirium in an older Portuguese surgical population with an overall low level of formal education, but rather that preoperative SctO2 may be helpful in identifying patients at risk for delirium.</abstract><cop>United States</cop><pub>Lippincott Williams & Wilkin</pub><pmid>33002925</pmid><doi>10.1213/ANE.0000000000005159</doi><tpages>10</tpages></addata></record> |
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| subjects | Age Factors Aged Aged, 80 and over Blood Gas Monitoring, Transcutaneous Cerebrovascular Circulation Cognition Cognitive Dysfunction - complications Cognitive Dysfunction - diagnosis Cognitive Dysfunction - psychology Delirium - diagnosis Delirium - etiology Delirium - psychology Elective Surgical Procedures - adverse effects Female Humans Male Neuropsychological Tests Oxygen - blood Portugal Postoperative Complications - diagnosis Postoperative Complications - etiology Postoperative Complications - psychology Prospective Studies Risk Assessment Risk Factors Spectroscopy, Near-Infrared Treatment Outcome |
| title | Association Among Preoperative Cognitive Performance, Regional Cerebral Oxygen Saturation, and Postoperative Delirium in Older Portuguese Patients |
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