Does cognition influence the perioperative trajectory of health-related quality of life? A longitudinal prospective cohort study

IF 2.7 2区医学 Q1 SURGERY

Surgery Pub Date : 2025-06-02 DOI:10.1016/j.surg.2025.109450

Ellene Yan HBSc , Yasmin Alhamdah MSc , Nina Butris MSc , Paras Kapoor MSc , Leif Erik Lovblom PhD , Jean Wong MD , Aparna Saripella MSc , David He MD, PhD , Frances Chung MD, FRCPC

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引用次数: 0

Abstract

Background

Further characterization is needed to capture the trajectory of health-related quality of life in older surgical populations with cognitive impairment. This study aimed to (1) compare the perioperative trajectory of health-related quality of life between older noncardiac surgical patients with and without cognitive impairment; (2) assess preoperative health-related quality of life values associated with adverse clinical outcomes; and (3) explore preoperative factors associated with poorer health-related quality of life over time.

Methods

Health-related quality of life was assessed online using the EuroQol 5-Dimension 5-Level questionnaire preoperatively and postoperatively at 30, 90, and 180 days. A greater score indicated greater health-related quality of life. Cognition was assessed preoperatively using the Ascertain Dementia Eight-item Questionnaire and the Telephone Montreal Cognitive Assessment. Participants identified as having probable cognitive impairment were referred to as having cognitive impairment.

Results

EuroQol 5-Dimension 5-Level questionnaire scores significantly improved within 30 days postoperatively (0.718 ± 0.012 vs 0.690 ± 0.011, P = .04), with sustained gains at 90 (0.784 ± 0.013 vs 0.690 ± 0.011, P ≤ .001) and 180 days (0.797 ± 0.013 vs 0.690 ± 0.011, P ≤ .001). Although participants with cognitive impairment on the Ascertain Dementia Eight-item Questionnaire and those undergoing orthopedic surgery reported poorer health-related quality of life than their counterparts, they exhibited a greater rate of improvement over time. Lower education level, higher pain level, functional disability, depression, and having orthopedic surgery were associated with poorer health-related quality of life across all time points. Poorer preoperative health-related quality of life was associated with a higher incidence of delirium and non-home discharge.

Conclusion

Health-related quality of life improves by 30 days postoperatively, with a greater rate of improvement among those with cognitive impairment on the Ascertain Dementia Eight-item Questionnaire and those undergoing orthopedic surgery.

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认知是否影响围手术期与健康相关的生活质量？一项纵向前瞻性队列研究

背景：需要进一步的表征来捕捉认知障碍老年外科人群与健康相关的生活质量的轨迹。本研究旨在(1)比较有认知障碍和无认知障碍的老年非心脏手术患者的围手术期健康相关生活质量轨迹；(2)评估术前与不良临床结局相关的健康相关生活质量值；(3)探讨术前与较差的健康相关生活质量相关的因素。方法术前、术后30、90、180天采用EuroQol 5维5级问卷在线评估健康相关生活质量。得分越高，表明与健康相关的生活质量越高。术前使用痴呆八项问卷和电话蒙特利尔认知评估评估认知能力。被认为可能有认知障碍的参与者被认为有认知障碍。结果uroqol 5维5水平问卷评分在术后30天内（0.718±0.012 vs 0.690±0.011,P = 0.04）显著改善，在术后90天（0.784±0.013 vs 0.690±0.011,P≤0.001）和180天（0.797±0.013 vs 0.690±0.011,P≤0.001）持续改善。尽管在确定痴呆八项调查问卷中有认知障碍的参与者和接受整形手术的参与者报告的与健康相关的生活质量较差，但随着时间的推移，他们表现出更大的改善速度。在所有时间点上，低教育水平、高疼痛程度、功能残疾、抑郁和接受骨科手术与较差的健康相关生活质量相关。术前健康相关生活质量较差与谵妄和非居家出院的发生率较高相关。结论与健康相关的生活质量在术后30天得到改善，其中认知障碍患者和接受骨科手术的患者的改善率更高。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Surgery 医学-外科

CiteScore

5.40

自引率

5.30%

发文量

687

审稿时长

64 days

期刊介绍： For 66 years, Surgery has published practical, authoritative information about procedures, clinical advances, and major trends shaping general surgery. Each issue features original scientific contributions and clinical reports. Peer-reviewed articles cover topics in oncology, trauma, gastrointestinal, vascular, and transplantation surgery. The journal also publishes papers from the meetings of its sponsoring societies, the Society of University Surgeons, the Central Surgical Association, and the American Association of Endocrine Surgeons.