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Amini S, Crowley S, Hizel L, Arias F, Libon DJ, Tighe P, Giordano C, Garvan CW, Enneking FK, Price CC. Feasibility and Rationale for Incorporating Frailty and Cognitive Screening Protocols in a Preoperative Anesthesia Clinic. Anesth Analg 2019; 129:830-838. [PMID: 31425227 PMCID: PMC6927245 DOI: 10.1213/ane.0000000000004190] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Advanced age, frailty, low education level, and impaired cognition are generally reported to be associated with postoperative cognitive complications. To translate research findings into hospital-wide preoperative assessment clinical practice, we examined the feasibility of implementing a preoperative frailty and cognitive assessment for all older adults electing surgical procedures in a tertiary medical center. We examined associations among age, education, frailty, and comorbidity with the clock and 3-word memory scores, estimated the prevalence of mild to major cognitive impairment in the presurgical sample, and examined factors related to hospital length of stay. METHODS Medical staff screened adults ≥65 years of age for frailty, general cognition (via the clock-drawing test command and copy, 3-word memory test), and obtained years of education. Feasibility was studied in 2 phases: (1) a pilot phase involving 4 advanced nurse practitioners and (2) a 2-month implementation phase involving all preoperative staff. We tracked sources of missing data, investigated associations of study variables with measures of cognition, and used 2 approaches to estimate the likelihood of dementia in our sample (ie, using extant data and logistic regression modeling and using Mini-Cog cut scores). We explored which protocol variables related to hospital length of stay. RESULTS The final implementation phase sample included 678 patients. Clock and 3-word memory scores were significantly associated with age, frailty, and education. Education, clock scores, and 3-word scores were not significantly different by surgery type. Likelihood of preoperative cognitive impairment was approximately 20%, with no difference by surgery type. Length of stay was significantly associated with preoperative comorbidity and performance on the clock copy condition. CONCLUSIONS Frailty and cognitive screening protocols are feasible and provide information for perioperative care planning. Challenges to clinical adaptation include staff training, missing data, and additional administration time. These challenges appear minimal relative to the benefits of identifying frailty and cognitive impairment in a group at risk for negative postoperative cognitive outcome.
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Affiliation(s)
- Shawna Amini
- Department of Clinical and Health Psychology, University of Florida College of Public Health and Health Professions, Gainesville, Florida
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida
- Perioperative Cognitive Anesthesia Network, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, Florida
| | - Samuel Crowley
- Department of Clinical and Health Psychology, University of Florida College of Public Health and Health Professions, Gainesville, Florida
| | - Loren Hizel
- Department of Clinical and Health Psychology, University of Florida College of Public Health and Health Professions, Gainesville, Florida
| | - Franchesca Arias
- Department of Clinical and Health Psychology, University of Florida College of Public Health and Health Professions, Gainesville, Florida
- Perioperative Cognitive Anesthesia Network, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, Florida
| | - David J. Libon
- Department of Geriatrics, Rowan University, School of Osteopathic Medicine, New Jersey Institute for Successful Aging, Stratford, New Jersey
- Department of Gerontology, Rowan University, School of Osteopathic Medicine, New Jersey Institute for Successful Aging, Stratford, New Jersey
- Department of Psychology, Rowan University, School of Osteopathic Medicine, New Jersey Institute for Successful Aging, Stratford, New Jersey
| | - Patrick Tighe
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida
- Perioperative Cognitive Anesthesia Network, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, Florida
| | - Chris Giordano
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida
| | - Cynthia W. Garvan
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida
| | - F. Kayser Enneking
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida
| | - Catherine C. Price
- Department of Clinical and Health Psychology, University of Florida College of Public Health and Health Professions, Gainesville, Florida
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida
- Perioperative Cognitive Anesthesia Network, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, Florida
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Price CC, Levy SA, Tanner J, Garvan C, Ward J, Akbar F, Bowers D, Rice M, Okun M. Orthopedic Surgery and Post-Operative Cognitive Decline in Idiopathic Parkinson's Disease: Considerations from a Pilot Study. JOURNAL OF PARKINSONS DISEASE 2016; 5:893-905. [PMID: 26683785 DOI: 10.3233/jpd-150632] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Post-operative cognitive dysfunction (POCD) demarks cognitive decline after major surgery but has been studied to date in "healthy" adults. Although individuals with neurodegenerative disorders such as Parkinson's disease (PD) commonly undergo elective surgery, these individuals have yet to be prospectively followed despite hypotheses of increased POCD risk. OBJECTIVE To conduct a pilot study examining cognitive change pre-post elective orthopedic surgery for PD relative to surgery and non-surgery peers. METHODS A prospective one-year longitudinal design. No-dementia idiopathic PD individuals were actively recruited along with non-PD "healthy" controls (HC) undergoing knee replacement surgery. Non-surgical PD and HC controls were also recruited. Attention/processing speed, inhibitory function, memory recall, animal (semantic) fluency, and motor speed were assessed at baseline (pre-surgery), 3 weeks, 3 months, and 1 year post- orthopedic surgery. Reliable change methods examined individual changes for PD individuals relative to control surgery and control non-surgery peers. RESULTS Over two years we screened 152 older adult surgery or non-surgery candidates with 19 of these individuals having a diagnosis of PD. Final participants included 8 PD (5 surgery, 3 non-surgery), 47 Control Surgery, and 21 Control Non-Surgery. Eighty percent (4 of the 5) PD surgery declined greater than 1.645 standard deviations from their baseline performance on measures assessing processing speed and inhibitory function. This was not observed for the non-surgery PD individuals. CONCLUSION This prospective pilot study demonstrated rationale and feasibility for examining cognitive decline in at-risk neurodegenerative populations. We discuss recruitment and design challenges for examining post-operative cognitive decline in neurodegenerative samples.
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Affiliation(s)
- Catherine C Price
- Clinical and Health Psychology, University of Florida, FL, USA.,Anesthesiology, University of Florida, FL, USA.,Center for Movement Disorders and Neurorestoration, University of Florida, FL, USA
| | | | - Jared Tanner
- Clinical and Health Psychology, University of Florida, FL, USA
| | - Cyndi Garvan
- College of Nursing, University of Florida, FL, USA
| | - Jade Ward
- Clinical and Health Psychology, University of Florida, FL, USA
| | - Farheen Akbar
- Clinical and Health Psychology, University of Florida, FL, USA
| | - Dawn Bowers
- Clinical and Health Psychology, University of Florida, FL, USA.,Center for Movement Disorders and Neurorestoration, University of Florida, FL, USA.,Neurology, University of Florida, FL, USA
| | - Mark Rice
- Anesthesiology, University of Florida, FL, USA.,Anesthesiology, Vanderbilt University, TN, USA
| | - Michael Okun
- Center for Movement Disorders and Neurorestoration, University of Florida, FL, USA.,Neurology, University of Florida, FL, USA
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