Independent Association Between Pre-Operative Cognitive Status and Discharge Location after Surgery: A Strategy to Reduce Resource use After Surgery For Deformity.

Independent Association Between Pre-Operative Cognitive Status and Discharge Location after Surgery: A Strategy to Reduce Resource use After Surgery For Deformity.

World Neurosurg. 2017 Oct 25;:

Authors: Adogwa O, Elsamadicy AA, Sergesketter A, Vuong VD, Moreno J, Cheng J, Karikari IO, Bagley CA

Abstract
BACKGROUND: The aim of this study is to determine if preoperative scores on a screening measure for cognitive status(the Saint Louis Mental Status), were associated with discharge to a location other than home in elderly patients undergoing surgery for deformity.
METHODS: Elderly subjects (≥65 years) undergoing a planned elective spinal surgery for correction of adult degenerative scoliosis were enrolled in this study. Pre-operative baseline cognition was assessed using the validated Saint Louis Mental Status (SLUMS) test. SLUMS is 11 questions with a maximum of 30-points. Mild-cognitive impairment (CI) was defined as a SLUMS-score between 21-26 points, and severe-CI as a SLUMS-score of ≤20-points. Normal cognition was defined as a SLUMS-score of ≥27-points. Post-operative length of stay and discharge location were recorded on all patients.
RESULTS: Eighty-two subjects were included, with mean 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 CI, patients with pre-operative CI were four-times more likely to be discharged to a facility (skilled nursing or acute rehabilitation) compared to patients with normal cognitive status (odds-ratio[OR] 3.93). In addition, patients that were non-ambulatory prior to surgery were also more likely to be discharged to a facility (odds-ratio[OR] 7.14) CONCLUSIONS: In geriatric patients undergoing surgery for deformity correction, cognitive screening prior to surgery can identify patients with impaired cognitive status who are less likely than those with normal cognitive status to return home after surgery.

PMID: 29081391 [PubMed - as supplied by publisher]

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