Cognitive impairment is associated with mortality in older adults in the emergency surgical setting: Findings from the Older Persons Surgical Outcomes Collaboration (OPSOC): A prospective cohort study

Andrew D. Ablett; Kathryn McCarthy; Ben Carter; Lyndsay Pearce; Michael Stechman; Susan Moug; Jonathan Hewitt; Phyo K. Myint; Older Persons Surgical Outcomes Collaboration (OPSOC)

doi:10.1016/j.surg.2018.10.013

Cognitive impairment is associated with mortality in older adults in the emergency surgical setting: Findings from the Older Persons Surgical Outcomes Collaboration (OPSOC): A prospective cohort study

Andrew D. Ablett, Kathryn McCarthy, Ben Carter, Lyndsay Pearce, Michael Stechman, Susan Moug, Jonathan Hewitt (Corresponding Author), Phyo K. Myint, Older Persons Surgical Outcomes Collaboration (OPSOC)

Research output: Contribution to journal › Article › peer-review

11 Citations (Scopus)

7 Downloads (Pure)

Abstract

Background

Cognitive impairment is prevalent in older surgical patients; however, the condition is greatly under-recognized, and outcomes associated with it are poorly understood.

Methods

This is a prospective multicenter cohort study of unselected consecutive older adults admitted to 5 emergency general surgical units across the United Kingdom participating in the Older Persons Surgical Outcomes Collaboration from 2013–2014. The effect of moderate cognitive impairment defined as ≤17, bottom quartile of Montreal Cognitive Assessment was examined using multivariate logistic regression models. Primary outcome measure was the relationship between a low Montreal Cognitive Assessment score (≤17) and mortality at 30 and 90 days. Secondary outcome measures included the association between having a low Montreal Cognitive Assessment and hospital length of stay.

Results

A total of 539 older patients admitted consecutively to 5 surgical units during the 2013 and 2014 study periods were included. The median age (interquartile range) was 76 years (70–82 years), the emergency operation rate was 13% (n = 72). The prevalence of cognitive impairment, using the traditional Montreal Cognitive Assessment cutoff score of ≤26, was 84.4% and, using the recently suggested cutoff score of ≤23, the prevalence was 61.0%. Multivariable analyses showed patients with a low Montreal Cognitive Assessment score (≤17) had a three-fold increase in 30-day mortality (adjusted odds ratio = 3.10; 95% confidence interval:1.19–8.11; P = .021) and an increased length of hospital stay (10 or more days; 1.80 [1.10–2.94; P = .02] and 14 or more days; 2.06 [1.17–3.61; P = .012]).

Conclusion

We recommend a routine cognitive assessment in an emergency surgical setting whenever feasible to help identify patients at risk of poor outcomes.

Original language	English
Pages (from-to)	978-984
Number of pages	7
Journal	Surgery
Volume	165
Issue number	5
Early online date	19 Nov 2018
DOIs	https://doi.org/10.1016/j.surg.2018.10.013
Publication status	Published - May 2019

Bibliographical note

Funded in part by the National Institute for Health Research (NIHR) Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London (BRC). A.D. Ablett was sponsored by Medical Research Scotland (MRS) for a summer research scholarship (Vac-1058-2017). MRS has no role in study design and interpretation of the study results.

Acknowledgments
Cardiff and Vale University Health Board: Maeve Middleton, Silas Fuller, Siti Abdul Jabar, Stephanie Thomas, Mathew Williams, Amy Black, Svetlana Kulikouskaya, Caroline Best, Andrew Forrester, Joseph Ereaut, James Moore, Dominic Hampson, Stephanie Owen, Shaanjan Islam, Nicolas Gill, Stephan Merrix, Jack Topham, Pip Killingworth, Syed Rahman, and Nurulaida Mohd Darus.

North Bristol NHS Trust: Madeline Tarant, Emily Benson, Tom Wright, Sarah Blake, Calum Honeyman, Simon Huf, Anni Dong, Indira Garaeva, Manuk Wijeyaratne, Michael Campbell, and Eng Hean the.

Royal Alexandra Hospital, Paisley: Mahua Chakrabati, Adam Tay, and Nurwasimah Haj Asnan.

NHS Grampian: Caroline McCormack, Tay Hui Sian, and Matthew Greig.

Central Manchester University Hospitals: Jen Law and Elizabeth Norr.

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Accepted Manuscript
© 2018. This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/
Accepted author manuscript, 395 KBLicence: CC BY-NC-ND

Cite this

Ablett, A. D., McCarthy, K., Carter, B., Pearce, L., Stechman, M., Moug, S., Hewitt, J., Myint, P. K., & Older Persons Surgical Outcomes Collaboration (OPSOC) (2019). Cognitive impairment is associated with mortality in older adults in the emergency surgical setting: Findings from the Older Persons Surgical Outcomes Collaboration (OPSOC): A prospective cohort study. Surgery, 165(5), 978-984. https://doi.org/10.1016/j.surg.2018.10.013

Cognitive impairment is associated with mortality in older adults in the emergency surgical setting: Findings from the Older Persons Surgical Outcomes Collaboration (OPSOC): A prospective cohort study. / Ablett, Andrew D.; McCarthy, Kathryn; Carter, Ben et al.
In: Surgery, Vol. 165, No. 5, 05.2019, p. 978-984.

Research output: Contribution to journal › Article › peer-review

Ablett, AD, McCarthy, K, Carter, B, Pearce, L, Stechman, M, Moug, S, Hewitt, J, Myint, PK & Older Persons Surgical Outcomes Collaboration (OPSOC) 2019, 'Cognitive impairment is associated with mortality in older adults in the emergency surgical setting: Findings from the Older Persons Surgical Outcomes Collaboration (OPSOC): A prospective cohort study', Surgery, vol. 165, no. 5, pp. 978-984. https://doi.org/10.1016/j.surg.2018.10.013

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title = "Cognitive impairment is associated with mortality in older adults in the emergency surgical setting: Findings from the Older Persons Surgical Outcomes Collaboration (OPSOC): A prospective cohort study",

abstract = "BackgroundCognitive impairment is prevalent in older surgical patients; however, the condition is greatly under-recognized, and outcomes associated with it are poorly understood.MethodsThis is a prospective multicenter cohort study of unselected consecutive older adults admitted to 5 emergency general surgical units across the United Kingdom participating in the Older Persons Surgical Outcomes Collaboration from 2013–2014. The effect of moderate cognitive impairment defined as ≤17, bottom quartile of Montreal Cognitive Assessment was examined using multivariate logistic regression models. Primary outcome measure was the relationship between a low Montreal Cognitive Assessment score (≤17) and mortality at 30 and 90 days. Secondary outcome measures included the association between having a low Montreal Cognitive Assessment and hospital length of stay.ResultsA total of 539 older patients admitted consecutively to 5 surgical units during the 2013 and 2014 study periods were included. The median age (interquartile range) was 76 years (70–82 years), the emergency operation rate was 13% (n = 72). The prevalence of cognitive impairment, using the traditional Montreal Cognitive Assessment cutoff score of ≤26, was 84.4% and, using the recently suggested cutoff score of ≤23, the prevalence was 61.0%. Multivariable analyses showed patients with a low Montreal Cognitive Assessment score (≤17) had a three-fold increase in 30-day mortality (adjusted odds ratio = 3.10; 95% confidence interval:1.19–8.11; P = .021) and an increased length of hospital stay (10 or more days; 1.80 [1.10–2.94; P = .02] and 14 or more days; 2.06 [1.17–3.61; P = .012]).ConclusionWe recommend a routine cognitive assessment in an emergency surgical setting whenever feasible to help identify patients at risk of poor outcomes.",

author = "Ablett, {Andrew D.} and Kathryn McCarthy and Ben Carter and Lyndsay Pearce and Michael Stechman and Susan Moug and Jonathan Hewitt and Myint, {Phyo K.} and {Older Persons Surgical Outcomes Collaboration (OPSOC)}",

note = "Funded in part by the National Institute for Health Research (NIHR) Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London (BRC). A.D. Ablett was sponsored by Medical Research Scotland (MRS) for a summer research scholarship (Vac-1058-2017). MRS has no role in study design and interpretation of the study results. Acknowledgments Cardiff and Vale University Health Board: Maeve Middleton, Silas Fuller, Siti Abdul Jabar, Stephanie Thomas, Mathew Williams, Amy Black, Svetlana Kulikouskaya, Caroline Best, Andrew Forrester, Joseph Ereaut, James Moore, Dominic Hampson, Stephanie Owen, Shaanjan Islam, Nicolas Gill, Stephan Merrix, Jack Topham, Pip Killingworth, Syed Rahman, and Nurulaida Mohd Darus. North Bristol NHS Trust: Madeline Tarant, Emily Benson, Tom Wright, Sarah Blake, Calum Honeyman, Simon Huf, Anni Dong, Indira Garaeva, Manuk Wijeyaratne, Michael Campbell, and Eng Hean the. Royal Alexandra Hospital, Paisley: Mahua Chakrabati, Adam Tay, and Nurwasimah Haj Asnan. NHS Grampian: Caroline McCormack, Tay Hui Sian, and Matthew Greig. Central Manchester University Hospitals: Jen Law and Elizabeth Norr.",

year = "2019",

month = may,

doi = "10.1016/j.surg.2018.10.013",

language = "English",

volume = "165",

pages = "978--984",

journal = "Surgery",

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TY - JOUR

T1 - Cognitive impairment is associated with mortality in older adults in the emergency surgical setting

T2 - Findings from the Older Persons Surgical Outcomes Collaboration (OPSOC): A prospective cohort study

AU - Ablett, Andrew D.

AU - McCarthy, Kathryn

AU - Carter, Ben

AU - Pearce, Lyndsay

AU - Stechman, Michael

AU - Moug, Susan

AU - Hewitt, Jonathan

AU - Myint, Phyo K.

AU - Older Persons Surgical Outcomes Collaboration (OPSOC)

N1 - Funded in part by the National Institute for Health Research (NIHR) Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London (BRC). A.D. Ablett was sponsored by Medical Research Scotland (MRS) for a summer research scholarship (Vac-1058-2017). MRS has no role in study design and interpretation of the study results. Acknowledgments Cardiff and Vale University Health Board: Maeve Middleton, Silas Fuller, Siti Abdul Jabar, Stephanie Thomas, Mathew Williams, Amy Black, Svetlana Kulikouskaya, Caroline Best, Andrew Forrester, Joseph Ereaut, James Moore, Dominic Hampson, Stephanie Owen, Shaanjan Islam, Nicolas Gill, Stephan Merrix, Jack Topham, Pip Killingworth, Syed Rahman, and Nurulaida Mohd Darus. North Bristol NHS Trust: Madeline Tarant, Emily Benson, Tom Wright, Sarah Blake, Calum Honeyman, Simon Huf, Anni Dong, Indira Garaeva, Manuk Wijeyaratne, Michael Campbell, and Eng Hean the. Royal Alexandra Hospital, Paisley: Mahua Chakrabati, Adam Tay, and Nurwasimah Haj Asnan. NHS Grampian: Caroline McCormack, Tay Hui Sian, and Matthew Greig. Central Manchester University Hospitals: Jen Law and Elizabeth Norr.

PY - 2019/5

Y1 - 2019/5

N2 - BackgroundCognitive impairment is prevalent in older surgical patients; however, the condition is greatly under-recognized, and outcomes associated with it are poorly understood.MethodsThis is a prospective multicenter cohort study of unselected consecutive older adults admitted to 5 emergency general surgical units across the United Kingdom participating in the Older Persons Surgical Outcomes Collaboration from 2013–2014. The effect of moderate cognitive impairment defined as ≤17, bottom quartile of Montreal Cognitive Assessment was examined using multivariate logistic regression models. Primary outcome measure was the relationship between a low Montreal Cognitive Assessment score (≤17) and mortality at 30 and 90 days. Secondary outcome measures included the association between having a low Montreal Cognitive Assessment and hospital length of stay.ResultsA total of 539 older patients admitted consecutively to 5 surgical units during the 2013 and 2014 study periods were included. The median age (interquartile range) was 76 years (70–82 years), the emergency operation rate was 13% (n = 72). The prevalence of cognitive impairment, using the traditional Montreal Cognitive Assessment cutoff score of ≤26, was 84.4% and, using the recently suggested cutoff score of ≤23, the prevalence was 61.0%. Multivariable analyses showed patients with a low Montreal Cognitive Assessment score (≤17) had a three-fold increase in 30-day mortality (adjusted odds ratio = 3.10; 95% confidence interval:1.19–8.11; P = .021) and an increased length of hospital stay (10 or more days; 1.80 [1.10–2.94; P = .02] and 14 or more days; 2.06 [1.17–3.61; P = .012]).ConclusionWe recommend a routine cognitive assessment in an emergency surgical setting whenever feasible to help identify patients at risk of poor outcomes.

AB - BackgroundCognitive impairment is prevalent in older surgical patients; however, the condition is greatly under-recognized, and outcomes associated with it are poorly understood.MethodsThis is a prospective multicenter cohort study of unselected consecutive older adults admitted to 5 emergency general surgical units across the United Kingdom participating in the Older Persons Surgical Outcomes Collaboration from 2013–2014. The effect of moderate cognitive impairment defined as ≤17, bottom quartile of Montreal Cognitive Assessment was examined using multivariate logistic regression models. Primary outcome measure was the relationship between a low Montreal Cognitive Assessment score (≤17) and mortality at 30 and 90 days. Secondary outcome measures included the association between having a low Montreal Cognitive Assessment and hospital length of stay.ResultsA total of 539 older patients admitted consecutively to 5 surgical units during the 2013 and 2014 study periods were included. The median age (interquartile range) was 76 years (70–82 years), the emergency operation rate was 13% (n = 72). The prevalence of cognitive impairment, using the traditional Montreal Cognitive Assessment cutoff score of ≤26, was 84.4% and, using the recently suggested cutoff score of ≤23, the prevalence was 61.0%. Multivariable analyses showed patients with a low Montreal Cognitive Assessment score (≤17) had a three-fold increase in 30-day mortality (adjusted odds ratio = 3.10; 95% confidence interval:1.19–8.11; P = .021) and an increased length of hospital stay (10 or more days; 1.80 [1.10–2.94; P = .02] and 14 or more days; 2.06 [1.17–3.61; P = .012]).ConclusionWe recommend a routine cognitive assessment in an emergency surgical setting whenever feasible to help identify patients at risk of poor outcomes.

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DO - 10.1016/j.surg.2018.10.013

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SN - 0039-6060

VL - 165

SP - 978

EP - 984

JO - Surgery

JF - Surgery

IS - 5

ER -

Cognitive impairment is associated with mortality in older adults in the emergency surgical setting: Findings from the Older Persons Surgical Outcomes Collaboration (OPSOC): A prospective cohort study

Abstract

Bibliographical note

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