Preoperative cognitive screening in vascular surgery patients
Authors:
M. Horáček
Authors place of work:
Klinika anesteziologie, resuscitace a intenzivní medicíny, 2. lékařská fakulta Univerzity Karlovy a Fakultní nemocnice v Motole
Published in the journal:
Anest. intenziv. Med., 30, 2019, č. 2, s. 60-67
Category:
Summary
Objective: To determine the proportion of patients with possible cognitive dysfunction in a population of seniors ≥ 60 years undergoing elective vascular surgical procedures at the pre-anaesthetic visit, and to examine if there is a difference in cognitive functions among individual categories of vascular surgical procedures. The secondary aim was to find if such cognitive testing is feasible and acceptable for patients.
Design: Prospective, observational trial.
Setting: Department of vascular surgery at a teaching hospital.
Materials and methods: Following ethical board approval, consecutive patients ≥ 60 years of age planned for elective vascular surgical procedures were approached between July 1st 2017 and June 30th 2018. Exclusion criteria: Documented dementia or mental retardation, serious disorders of senses, inability to use the dominant hand, language barrier. To determine the cognitive function, a short screening Clock-in-the-Box (CIB) test was used.
Outcome parameter: The proportion of patients with possible cognitive dysfunction was defined by CIB score ≤ 5 (range 0-8). The significance of differences among individual categories of surgical procedures was evaluated with χ2-test, P ≤ 0.05.
Results: 122 patients were approached, of whom 100 were analysed, 63 of them male, mean age 70.7 ± 7 years, education mostly lower than completed secondary, ASA 3. Possible cognitive dysfunction was identified in 34 patients, the differences between the surgical categories (aorta, arterial reconstruction on the lower extremities, carotid endarterectomies, varicose veins) were not significant. CIB test during the pre-anaesthetic visit was feasible and not a burden for patients who considered it useful and would agree to it in future, if necessary.
Conclusion: One third of seniors undergoing elective surgical vascular procedures show pre-existing possible cognitive dysfunction based on a clock-drawing (Clock-in-the-Box) test. The test is sufficiently short, feasible during the pre-anaesthetic visit and acceptable for the patients.
Keywords:
cognitive functions – pre-anaesthetic evaluation – clock-drawing test – Clock-in-the-Box test
Zdroje
1. Drábková J. Statistika oboru anesteziologie a resuscitace za rok 2016. Referátový výběr z anesteziologie, resuscitace a intenzivní medicíny. 2017;64:67–75.
2. Doporučený postup interního předoperačního vyšetření před elektivními operačními výkony. Věstník ministerstva zdravotnictví České republiky 2018;částka 1:35–49. Dostupné z: http://www.mzcr.cz/Legislativa/dokumenty/vestnik-c1/2018_14762_3810_11.html [cit 2019 Jan 14].
3. Doporučený postup ČSARIM pro tzv. předanestetické vyšetření. Dostupné z: http://www.csarim.cz/dokumenty/ [cit 2019 Jan 14].
4. Crosby G, Culley DJ, Hyman BT. Preoperative cognitive assessment of the elderly surgical patient: a call for action. Anesthesiology. 2011;114:1265–1268. doi: 10.1097/ALN.0b013e31821b1bc8.
5. Česká alzheimerovská společnost: Zpráva o stavu demence 2014. Dostupné z: http://www.alzheimer.cz/publikace/zpravy-o-stavu/ [cit 2018 Dec 21].
6. Chow WB, Rosenthal RA, Merkow RP, et al.; American College of Surgeons National Surgical Quality Improvement Program, American Geriatrics Society. Optimal preoperative assessment of the geriatric surgical patient: a best practices guideline from the American College of Surgeons National Surgical Quality Improvement Program and the American Geriatrics Society. J Am Coll Surg. 2012;215:453–466.
7. De Hert S, Staender S, Fritsch G, et al. Pre-operative evaluation of adults undergoing elective noncardiac surgery: Updated guideline from the European Society of Anaesthesiology. Eur J Anaesthesiol. 2018;35:407–465. doi: 10.1097/EJA. 0000000000000817.
8. MacKenzie KK, Britt-Spells AM, Sands LP, Leung JM. Processed electroencephalogram monitoring and postoperative delirium: a systematic review and meta-analysis. Anesthesiology. 2018;129:417–427. doi: 10.1097/ALN.0000000000002323.
9. Bodník. Seznam výkonů on-line. Dostupné z http://www.bodnik.cz/seznam/134/odb/708.html [cit 2019 Jan 14].
10. Berger M, Schenning KJ, Brown CH 4th, et al.; Perioperative Neurotoxicity Working Group. Best practices for postoperative brain health: recommendations from the Fifth International Perioperative Neurotoxicity Working Group. Anesth Analg. 2018;127:1406–1413. doi: 10.1213/ANE.0000000000003841.
11. Chester JG, Grande LJ, Milberg WP, et al. Cognitive screening in community-dwelling elders: performance on the clock-in-the-box. Am J Med. 2011;124:662–669. doi: 10.1016/j.amjmed.2011.02.023.
12. Culley DJ, Flaherty D, Reddy S, et al. Preoperative cognitive stratification of older elective surgical patients: a cross-sectional study. Anesth Analg. 2016;123:186–192. doi: 10.1213/ANE.0000000000001277.
13. How to Score the Clock-in-the-Box. Dostupné z: http://heartbrain.com/cib/clockinstructions.htm [cit 2018 Dec 21].
14. Chi-Square Test Calculator, Social Science Statistics. Dostupné z: https://www.socscistatistics.com/tests/chisquare2/Default2.aspx [cit 2019 Jan 14].
15. Jackson CE, Grande LJ, Doherty K, et al. The Clock-in-the-Box, a brief cognitive screen, is associated with failure to return home in an elderly hospitalized sample. Clin Interv Aging. 2016;11:1715–1721. eCollection 2016. doi: 10.2147/CIA.S118235. Dostupné z: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5125981/ [cit 2019 Jan 16].
16. Ciesielska N, Sokołowski R, Mazur E, et al. Is the Montreal Cognitive Assessment (MoCA) test better suited than the Mini-Mental State Examination (MMSE) in mild cognitive impairment (MCI) detection among people aged over 60? Meta-analysis. Psychiatr Pol. 2016;50:1039–1052. doi: 10.12740/PP/45368.
17. Bartoš A. Test gest (TEGEST) k rychlému vyšetření epizodické paměti u mírné kognitivní poruchy. Cesk Slov Neurol N. 2018;114:37–44.
18. Stoicea N, Koehler KN, Scharre DW, Bergese SD. Cognitive self-assessment scales in surgical settings: Acceptability and feasibility. Best Pract Res Clin Anaesthesiol. 2018;32:303–309. doi: 10.1016/j.bpa.2018.08.001.
19. Scharre DW, Chang SI, Murden RA, et al. Self-administered Gerocognitive Examination (SAGE): a brief cognitive assessment Instrument for mild cognitive impairment (MCI) and early dementia. Alzheimer Dis Assoc Disord 2010;24:64–71. doi: 10.1097/WAD.0b013e3181b03277.
20. Partridge JS, Dhesi JK, Cross JD, et al. The prevalence and impact of undiagnosed cognitive impairment in older vascular surgical patients. J Vasc Surg. 2014;60:1002–1011. doi: 10.1016/j.jvs.2014.04.041.
21. Styra R, Larsen E, Dimas MA, et al. The effect of preoperative cognitive impairment and type of vascular surgery procedure on postoperative delirium with associated cost implications. J Vasc Surg. 2019;69:201–209. doi: 10.1016/j.jvs.2018.05.001.
22. Robinson TN, Wu DS, Pointer LF, et al. Preoperative cognitive dysfunction is related to adverse postoperative outcomes in the elderly. J Am Coll Surg. 2012;215:12–27. doi: 10.1016/j.jamcollsurg.2012.02.007.
23. Adogwa O, Elsamadicy AA, Lydon E, et al. The prevalence of undiagnosed pre-surgical cognitive impairment and its post-surgical clinical impact in elderly patients undergoing surgery for adult spinal deformity. J Spine Surg. 2017;3:358–363. doi: 10.21037/jss.2017.07.01.
24. Culley DJ, Flaherty D, Fahey MC, et al. Poor performance on a preoperative cognitive screening test predicts postoperative complications in older orthopedic surgical patients. Anesthesiology. 2017;127:765–774. doi: 10.1097/ALN.0000000000001859.
25. Makhani SS, Kim FY, Liu Y, et al. Cognitive impairment and overall survival in frail surgical patients. J Am Coll Surg. 2017;225:590–600. doi: 10.1016/j.jamcollsurg.2017.07.1066.
26. Bartoš A, Janoušek M, Petroušová R, Hohinová M. Tři časy Testu kreslení hodin hodnocené BaJa skórováním u časné Alzheimerovy nemoci. Cesk Slov Neurol N. 2016,79:406–412.
Štítky
Anaesthesiology, Resuscitation and Inten Intensive Care MedicineČlánok vyšiel v časopise
Anaesthesiology and Intensive Care Medicine
2019 Číslo 2
Najčítanejšie v tomto čísle
- Clinical nutrition in surgery – ESPEN guideline with consensual voting of the working group of Society of Clinical Nutrition and Intensive Metabolic Care (SKVIMP
- Montgomery T tube in a management of inoperable tracheal stenosis
- Online resources in intensive care medicine
- Anaesthesia for minor surgery in the early postpartum period – Czech and Slovak prospective national surveys