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Impact of the Choice of Risk Model for Identifying Low-risk Patients Using the 2014 ACC/AHA Perioperative Guidelines
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Background: The American College of Surgeons and the American Geriatrics Society have suggested that preoperative cognitive screening should be performed in older surgical patients. We hypothesized that unrecognized cognitive impairment in patients without a history of dementia is a risk factor for development of postoperative complications.Methods: We enrolled 211 patients 65 yr of age or older without a diagnosis of dementia who were scheduled for an elective hip or knee replacement. Patients were cognitively screened preoperatively using the Mini-Cog and demographic, medical, functional, and emotional/social data were gathered using standard instruments or review of the medical record. Outcomes included discharge to place other than home (primary outcome), delirium, in-hospital medical complications, hospital lengthof-stay, 30-day emergency room visits, and mortality. Data were analyzed using univariate and multivariate analyses.Results: Fifty of 211 (24%) patients screened positive for probable cognitive impairment (Mini-Cog less than or equal to 2). On age-adjusted multivariate analysis, patients with a Mini-Cog score less than or equal to 2 were more likely to be discharged to a place other than home (67% vs. 34%; odds ratio = 3.88, 95% CI = 1.58 to 9.55), develop postoperative delirium (21% vs. 7%; odds ratio = 4.52, 95% CI = 1.30 to 15.68), and have a longer hospital length of stay (hazard ratio = 0.63, 95% CI = 0.42 to 0.95) compared to those with a Mini-Cog score greater than 2.Conclusions: Many older elective orthopedic surgical patients have probable cognitive impairment preoperatively. Such impairment is associated with development of delirium postoperatively, a longer hospital stay, and lower likelihood of going home upon hospital discharge.
CME Credit: 1.00 AMA PRA Category 1 Credit™
Required Hardware / Software:Adobe Acrobat Reader, Internet connection. Web browser version must have been released within the last three years.
Activity Release Date:10/17/2017
Activity Expiration Date:10/16/2020
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Learning Objectives:After successfully completing this activity, the learner will be able to do the following:
-Counsel patients undergoing lower extremity joint replacement and their families on the risk of postoperative delirium (1, 2, 6)-Estimate the risk for discharge to a place other than home...
-Counsel patients undergoing lower extremity joint replacement and their families on the risk of postoperative delirium (1, 2, 6)-Estimate the risk for discharge to a place other than home (3, 4)-Evaluate the risk for increased length of hospitalization (5)
Faculty & Credentials:
Editor-in-Chief: Evan D. Kharasch, M.D., Ph.D., has reported receiving consulting fees from TEN Healthcare.
CME Editors: Leslie C. Jameson, M.D. has reported no relevant financial relationships with commercial interests. Dan J. Kopacz, M.D., has reported holding an equity position with SoloDex, LLC.
Authors: Deborah J. Culley, M.D., Devon Flaherty, M.D., M.P.H., Margaret C. Fahey, M.A., James L. Rudolph, M.D., Houman Javedan, M.D., Chuan-Chin Huang, Ph.D., John Wright, M.D., Angela M. Bader, M.D., M.P.H., Bradley T. Hyman, M.D., Ph.D., Deborah Blacker, M.D., Sc.D., Gregory Crosby, M.D., report no relevant financial relationships with commercial interests.
ASA Staff: Kari L. Lee, Editorial Manager, has reported no financial relationships with commercial interests. Ginger Clark, Senior Editor, has an equity position in Merck & Co.
Disclosure StatementThe American Society of Anesthesiologists remains strongly committed to providing the best available evidence-based clinical information to participants of this educational activity and requires an open disclosure of any potential conflict of interest identified by our faculty members. It is not the intent of the American Society of Anesthesiologists to eliminate all situations of potential conflict of interest, but rather to enable those who are working with the American Society of Anesthesiologists to recognize situations that may be subject to question by others. All disclosed conflicts of interest are reviewed by the educational activity course director/chair to ensure that such situations are properly evaluated and, if necessary, resolved. The American Society of Anesthesiologists educational standards pertaining to conflict of interest are intended to maintain the professional autonomy of the clinical experts inherent in promoting a balanced presentation of science. Through our review process, all American Society of Anesthesiologists CME activities are ensured of independent, objective, scientifically balanced presentations of information. Disclosure of any or no relationships will be made available for all educational activities.
DisclaimerThe information provided at this CME activity is for continuing education purposes only and is not meant to substitute for the independent medical judgment of a healthcare provider relative to diagnostic and treatment options of a specific patient’s medical condition.
Core Competencies: Medical knowledge
Target Audience: ANESTHESIOLOGY Journal CME is intended for anesthesiologists. Researchers and other health care professionals with an interest in anesthesiology may also participate.
CME Credit: 1.00 AMA PRA Category 1 Credit™
The American Society of Anesthesiologists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
The American Society of Anesthesiologists designates this journal-based CME activity for a maximum of 1.00 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
1.00 Non-physician Credit Non-physicians may receive a Certificate of Completion stating that this activity was designated for 1.00 AMA PRA Category 1 Credit(s)™.
Activity Release Date: 10/17/2017 Activity Expiration Date: 10/16/2020
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