Comparison of functional disability in older surgical patients with and without probable cognitive impairment: A longitudinal prospective cohort study.

Abstract

Background: Understanding the recovery trajectory of functional disability in older adults with cognitive impairment can enhance perioperative care through early identification of at-risk patients, risk stratification, and proactive post-discharge planning. This multicenter longitudinal study compared the prevalence and trajectory of functional disability preoperatively and at 30, 90, and 180 days postoperatively between 307 older non-cardiac surgical participants with and without probable cognitive impairment, and examined their incidence of adverse postoperative outcomes.

Methods: Online and telephone assessments were administered to assess cognition and functional disability. Cognition was assessed using the Ascertain Dementia Eight-item Questionnaire (AD8), with a preoperative score ≥2 classifying probable cognitive impairment. Functional disability was self-reported preoperatively and at 30, 90, and 180 days postoperatively using the 12-item World Health Organization Disability Assessment Schedule 2.0, with scores ≥ 16% indicating functional disability exceeding a patient-acceptable symptom state.

Results: Of 307 participants, 17% screened positive for probable cognitive impairment using the AD8 preoperatively. Participants with probable cognitive impairment had a significantly higher perioperative prevalence of functional disability than those without. Nevertheless, probable cognitive impairment did not modify the recovery pattern of functional disability. Additionally, probable cognitive impairment was associated with greater postoperative delirium (OR: 7.37 [95% CI 2.25, 25.97], P = 0.001) and 180-day emergency department visits (OR: 5.05 [95% CI 1.34, 18.92], P = 0.014) after age adjustment.

Conclusions: A positive AD8 screen was associated with greater perioperative functional disability and adverse clinical outcomes. Despite this heightened risk, we did not find evidence that probable cognitive impairment modified the recovery trajectory of functional disability. Our exploratory study suggests that the AD8 may be useful in guiding patient-centered preoperative discussions and identifying patients with probable cognitive impairment who may warrant closer perioperative monitoring.