TY - JOUR
T1 - Independent Association Between Preoperative Cognitive Status and Discharge Location After Surgery
T2 - A Strategy to Reduce Resource Use After Surgery for Deformity
AU - Adogwa, Owoicho
AU - Elsamadicy, Aladine A.
AU - Sergesketter, Amanda
AU - Vuong, Victoria D.
AU - Moreno, Jessica
AU - Cheng, Joseph
AU - Karikari, Isaac O.
AU - Bagley, Carlos A.
N1 - Publisher Copyright:
© 2017 Elsevier Inc.
PY - 2018/2
Y1 - 2018/2
N2 - Background: The aim of this study is to determine whether preoperative scores on a screening measure for cognitive status (the Saint Louis University mental status examination), were associated with discharge to a location other than home in older patients undergoing surgery for deformity. Methods: Older patients (≥65 years) undergoing a planned elective spinal surgery for correction of adult degenerative scoliosis were enrolled in this study. Preoperative baseline cognition was assessed using the validated Saint Louis University mental status (SLUMS) test. SLUMS is 11 questions with a maximum of 30 points. Mild cognitive impairment was defined as a SLUMS score of 21–26 points, and severe cognitive impairment as a SLUMS score of 20 points or greater. Normal cognition was defined as a SLUMS score of 27 points or more. Postoperative length of stay and discharge location were recorded on all patients. Results: Eighty-two subjects were included, with mean ± standard deviation age of 73.26 ± 6.08 years; 51% of patients were discharged to a facility (skilled nursing or acute rehabilitation). After adjustment for demographic variables, comorbidities, and baseline cognitive impairment, patients with preoperative cognitive impairment were 4-fold more likely to be discharged to a facility (skilled nursing or acute rehabilitation) compared with patients with normal cognitive status (odds ratio [OR], 3.93). In addition, patients who were not ambulatory before surgery were also more likely to be discharged to a facility (OR, 7.14). Conclusions: In geriatric patients undergoing surgery for deformity correction, cognitive screening before surgery can identify patients with impaired cognitive status who are less likely than those with normal cognitive status to return home after surgery.
AB - Background: The aim of this study is to determine whether preoperative scores on a screening measure for cognitive status (the Saint Louis University mental status examination), were associated with discharge to a location other than home in older patients undergoing surgery for deformity. Methods: Older patients (≥65 years) undergoing a planned elective spinal surgery for correction of adult degenerative scoliosis were enrolled in this study. Preoperative baseline cognition was assessed using the validated Saint Louis University mental status (SLUMS) test. SLUMS is 11 questions with a maximum of 30 points. Mild cognitive impairment was defined as a SLUMS score of 21–26 points, and severe cognitive impairment as a SLUMS score of 20 points or greater. Normal cognition was defined as a SLUMS score of 27 points or more. Postoperative length of stay and discharge location were recorded on all patients. Results: Eighty-two subjects were included, with mean ± standard deviation age of 73.26 ± 6.08 years; 51% of patients were discharged to a facility (skilled nursing or acute rehabilitation). After adjustment for demographic variables, comorbidities, and baseline cognitive impairment, patients with preoperative cognitive impairment were 4-fold more likely to be discharged to a facility (skilled nursing or acute rehabilitation) compared with patients with normal cognitive status (odds ratio [OR], 3.93). In addition, patients who were not ambulatory before surgery were also more likely to be discharged to a facility (OR, 7.14). Conclusions: In geriatric patients undergoing surgery for deformity correction, cognitive screening before surgery can identify patients with impaired cognitive status who are less likely than those with normal cognitive status to return home after surgery.
KW - Adult degenerative scoliosis
KW - Cognitive impairment
KW - Continuing care facilities
KW - Deformity
KW - Discharge planning
KW - Disposition
KW - Postoperative complications
KW - Preoperative planning
KW - Saint Louis University mental status
KW - Spine
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U2 - 10.1016/j.wneu.2017.10.081
DO - 10.1016/j.wneu.2017.10.081
M3 - Article
C2 - 29081391
AN - SCOPUS:85035207175
SN - 1878-8750
VL - 110
SP - e67-e72
JO - World neurosurgery
JF - World neurosurgery
ER -