Mini-Cog test predicts need for rehabilitation intervention during weaning after radical cystectomy.

Abstract

Background: This study aimed to determine whether preoperative cognitive screening using the Mini-Cognitive Assessment Instrument (Mini-Cog) was useful for predicting the need for postoperative rehabilitation intervention in patients with bladder cancer who underwent radical cystectomy.

Materials and methods: We collected the medical records of consecutive patients who underwent radical cystectomy and preoperative cognitive screening based on the Mini-Cog test in our department between 2020 and 2021 (n = 114). Univariate and multivariate logistic regression analyses were used to identify the clinical risk factors for requiring rehabilitation intervention because of failure to wean postoperatively.

Results: The median age of the participants was 76 years, and 96 (84%) were male. Of the 114 patients, 31 (27%) required rehabilitation intervention for weaning. Based on the Mini-Cog test, the patients were classified into 2 groups: 22 (19%) had probable cognitive impairment (Mini-Cog score <3). Of the 22 patients with a Mini-Cog score of <3, 13 (59%) required rehabilitation intervention because of failure to wean postoperatively. In the multivariate analysis, being 75 years or older (odds ratio [OR], 9.7; 95% confidence interval [CI], 2.6-36.3; p < 0.001), a Mini-Cog score of <3 (OR, 3.7; 95% CI, 1.2-11.2; p = 0.02), and an operative time ≥310 minutes (OR, 3.6; 95% CI, 1.1-11.9; p = 0.04) were independent risk factors for requiring postoperative rehabilitation intervention.

Conclusions: Effective screening with the Mini-Cog test, a simple cognitive screening tool with only 2 components (delayed 3-word recall task and clock drawing), reflects not only cognitive function but also physical frailty and may lead to the establishment of appropriate rehabilitation programs during the perioperative period for early patient mobility after surgery.