Preoperative Cognitive Screening Predicts Postoperative Ambulatory Recovery: A Pilot Study.

Abstract

Purpose: Cardiac surgery patients are older adults at risk for postoperative physical impairment. We hypothesize that screening for mild cognitive impairment (MCI) using the Montreal Cognitive Assessment (MoCA) may identify patients at risk for delayed physical recovery.

Patients and methods: This is a single center prospective cohort pilot study of patients undergoing elective cardiac surgery. Patients were screened preoperatively for MCI using the MoCA full version 8.1, with scores < 26 defined as a positive screen for MCI. Daily step count, as a practical measure of physical function, was continuously recorded from the preoperative period (baseline) through postoperative day 50 using a commercially available activity tracker.

Results: Eighteen patients met inclusion criteria. Eight (44%) screened positive for MCI and 10 (56%) screened non-impaired (NI). Baseline characteristics and operative outcomes were similar between the MCI and NI cohorts. The MCI cohort did not achieve their preoperative daily step count by postoperative day 50, whereas the NI cohort did so by postoperative day 37. There was a difference in median [IQR] postoperative daily step count (MCI: 3662[2292-5704] vs NI: 4497[2532-9216]; p < 0.001).

Conclusion: In a cohort of patients older than 60 undergoing cardiac surgery, a preoperative screen for MCI delayed postoperative physical recovery. A brief preoperative cognitive screen tool may identify patients who could benefit from early intervention for recovery of physical function.