April 12, 2019
by Sandra Gordon for ASA
Brigham and Women’s Hospital, which is affiliated with Harvard Medical School, recently began implementing preoperative cognitive screening for all surgical patients 65 years and older. The new protocol is the result of research published in Anesthesiology in November 2017, which screened 211 patients 65 years and older without a diagnosis of dementia who were scheduled for an elective hip or knee replacement.
Using the Mini-Cog, a two-minute screening test that requires patients to remember a few words and draw a clock with the hands set to a specific time, the study found that 24 percent of patients screened positive for probable cognitive impairment.
“The Mini-Cog is a way to identify patients who is at higher risk for postoperative delirium,” says Gregory Crosby, M.D., anesthesiologist at Brigham and Women’s Hospital in the department of perioperative and pain medicine and associate professor of anesthesia at Harvard Medical School, who was one of the study’s researchers.
At Brigham and Women’s Hospital, the results of a patient’s Mini-Cog are noted in the patient’s chart. Ideally, a geriatrician then gets involved in the patient’s care in a preop clinic. The hospital is in the development stage of implementing next steps. More research needs to be done to determine the implications for patient care, Dr. Crosby says.
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