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 journalArticle

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 languageEnglish
Pages (from-to)978-984
Number of pages7
JournalSurgery
Volume165
Issue number5
Early online date19 Nov 2018
DOIs
Publication statusPublished - May 2019

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Length of Stay
Emergencies
Cohort Studies
Prospective Studies
Mortality
Logistic Models
Outcome Assessment (Health Care)
Confidence Intervals
Cognitive Dysfunction

Cite this

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; Pearce, Lyndsay; Stechman, Michael; Moug, Susan; Hewitt, Jonathan (Corresponding Author); Myint, Phyo K.; Older Persons Surgical Outcomes Collaboration (OPSOC).

In: Surgery, Vol. 165, No. 5, 05.2019, p. 978-984.

Research output: Contribution to journalArticle

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
Ablett, Andrew D. ; McCarthy, Kathryn ; Carter, Ben ; Pearce, Lyndsay ; Stechman, Michael ; Moug, Susan ; Hewitt, Jonathan ; Myint, Phyo K. ; Older Persons Surgical Outcomes Collaboration (OPSOC). / 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. In: Surgery. 2019 ; Vol. 165, No. 5. pp. 978-984.
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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 = "5",
doi = "10.1016/j.surg.2018.10.013",
language = "English",
volume = "165",
pages = "978--984",
journal = "Surgery",
issn = "0039-6060",
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number = "5",

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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.

UR - http://www.mendeley.com/research/cognitive-impairment-associated-mortality-older-adults-emergency-surgical-setting-findings-older-per

U2 - 10.1016/j.surg.2018.10.013

DO - 10.1016/j.surg.2018.10.013

M3 - Article

VL - 165

SP - 978

EP - 984

JO - Surgery

JF - Surgery

SN - 0039-6060

IS - 5

ER -