185 The Prevalence of Undiagnosed Pre-Surgical Cognitive Impairment and Its Post-Surgical Clinical Impact in Elderly Patients Undergoing Surgery for Adult Spinal Deformity

Neurosurgery ◽  
2017 ◽  
Vol 64 (CN_suppl_1) ◽  
pp. 249-249
Author(s):  
Owoicho Adogwa ◽  
Aladine A Elsamadicy ◽  
Emily Lydon ◽  
Victoria Vuong ◽  
Joseph S Cheng ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Elderly Patients ◽  
Hospital Stay ◽  
Adult Spinal Deformity ◽  
Elderly Subjects ◽  
Complication Rates ◽  
Degenerative Scoliosis ◽  
Readmission Rates ◽  
Adult Degenerative Scoliosis ◽  
Impaired Cognition

Abstract INTRODUCTION Pre-existing cognitive impairment (CI) is emerging as a predictor of poor post-operative outcomes in elderly patients. The purpose of this study was to assess the prevalence of neurocognitive impairment in elderly patients undergoing surgery for deformity and its impact on postoperative outcomes. METHODS Elderly subjects 65 years and older 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 made up of 11 questions, which can give a maximum of 30 points. Mild cognitive impairment was defined as a SLUMS score between 2126 points, while severe cognitive impairment was defined as a SLUMS score of =20 points. Normal cognition was defined as a SLUMS score of =27 points. Complication rates, duration of hospital stay and 30-day readmission rates were compared between patients with and without baseline cognitive impairment. RESULTS >Eighty-two subjects were included in this study, with mean age of 73.26 ± 6.08 years. Fifty-seven patients (70%) had impaired cognition at baseline. The impaired cognition group had the following outcomes: increased incidence of one or more postoperative complications (39% vs 20%), higher incidence of delirium (20% vs 8%) and higher rate of discharge institutionalization at skilled nursing or acute rehab facilities (54% vs 30%). However, the length of hospital stay and 30-day hospital readmission rates were similar between both cohorts (5.33 days vs. 5.48 days and 12.28% vs. 12%, respectively). CONCLUSION Cognitive impairment is highly prevalent in elderly patients undergoing surgery for adult degenerative scoliosis. Impaired cognition before surgery was associated with higher rates of post-operative delirium, complications, and discharge institutionalization. CI assessments should be considered in the pre-operative evaluations of elderly patients prior to surgery.

scholarly journals Association between baseline cognitive impairment and postoperative delirium in elderly patients undergoing surgery for adult spinal deformity

2018 ◽  
Vol 28 (1) ◽  
pp. 103-108 ◽  
Author(s):  
Owoicho Adogwa ◽  
Aladine A. Elsamadicy ◽  
Victoria D. Vuong ◽  
Jared Fialkoff ◽  
Joseph Cheng ◽  
...  
Keyword(s):  
Risk Factor ◽  
Cognitive Impairment ◽  
Elderly Patients ◽  
Postoperative Delirium ◽  
Adult Spinal Deformity ◽  
Functional Decline ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Degenerative Scoliosis ◽  
Patient Reported

OBJECTIVEPostoperative delirium is common in elderly patients undergoing spine surgery and is associated with a longer and more costly hospital course, functional decline, postoperative institutionalization, and higher likelihood of death within 6 months of discharge. Preoperative cognitive impairment may be a risk factor for the development of postoperative delirium. The aim of this study was to investigate the relationship between baseline cognitive impairment and postoperative delirium in geriatric patients undergoing surgery for degenerative scoliosis.METHODSElderly patients 65 years and older undergoing a planned elective spinal surgery for correction of adult degenerative scoliosis were enrolled in this study. Preoperative cognition was assessed using the validated Saint Louis University Mental Status (SLUMS) examination. SLUMS comprises 11 questions, with a maximum score of 30 points. Mild cognitive impairment was defined as a SLUMS score between 21 and 26 points, while severe cognitive impairment was defined as a SLUMS score of ≤ 20 points. Normal cognition was defined as a SLUMS score of ≥ 27 points. Delirium was assessed daily using the Confusion Assessment Method (CAM) and rated as absent or present on the basis of CAM. The incidence of delirium was compared in patients with and without baseline cognitive impairment.RESULTSTwenty-two patients (18%) developed delirium postoperatively. Baseline demographics, including age, sex, comorbidities, and perioperative variables, were similar in patients with and without delirium. The length of in-hospital stay (mean 5.33 days vs 5.48 days) and 30-day hospital readmission rates (12.28% vs 12%) were similar between patients with and without delirium, respectively. Patients with preoperative cognitive impairment (i.e., a lower SLUMS score) had a higher incidence of postoperative delirium. One- and 2-year patient reported outcomes scores were similar in patients with and without delirium.CONCLUSIONSCognitive impairment is a risk factor for the development of postoperative delirium. Postoperative delirium may be associated with decreased preoperative cognitive reserve. Cognitive impairment assessments should be considered in the preoperative evaluations of elderly patients prior to surgery.

scholarly journals Effect of Social Support and Marital Status on Perceived Surgical Effectiveness and 30-Day Hospital Readmission

2017 ◽  
Vol 7 (8) ◽  
pp. 774-779 ◽  
Author(s):  
Owoicho Adogwa ◽  
Aladine A. Elsamadicy ◽  
Victoria D. Vuong ◽  
Ankit I. Mehta ◽  
Raul A. Vasquez ◽  
...  
Keyword(s):  
Social Support ◽  
Hospital Stay ◽  
Marital Status ◽  
Spine Surgery ◽  
Patient Reported Outcomes ◽  
Complication Rates ◽  
Readmission Rates ◽  
Outcomes Measures ◽  
Significant Difference ◽  
Patient Reported

Study Design: Retrospective cohort review. Objective: To determine whether higher levels of social support are associated with improved surgical outcomes after elective spine surgery. Methods: The medical records of 430 patients (married, n = 313; divorced/separated/widowed, n = 71; single, n = 46) undergoing elective spine surgery at a major academic medical center were reviewed. Patients were categorized by their marital status at the time of surgery. Patient demographics, comorbidities, and postoperative complication rates were collected. All patients had prospectively collected outcomes measures and a minimum of 1-year follow-up. Patient reported outcomes instruments (Oswestry Disability Index, Short Form–36, and visual analog scale–back pain/leg pain) were completed before surgery, then at 1 year after surgery. Results: Baseline characteristics were similar in all cohorts. There was no statistically significant difference in the length of hospital stay across all 3 cohorts, although “single patients” had longer duration of in-hospital stays that trended toward significance (single 6.24 days vs married 4.53 days vs divorced/separated/widowed 4.55 days, P = .05). Thirty-day readmission rates were similar across all cohorts (married 7.03% vs divorced/separated/widowed 7.04% vs single 6.52%, P = .99). Additionally, there were no significant differences in baseline and 1-year patient reported outcomes measures between all groups. Conclusions: Increased social support did not appear to be associated with superior short and long-term clinical outcomes after spine surgery; however, it was associated with a shorter duration of in-hospital stay with no increase in 30-day readmission rates.

Morbidity and Mortality of C2 Fractures in the Elderly

Neurosurgery ◽  
2011 ◽  
Vol 70 (5) ◽  
pp. 1055-1059 ◽  
Author(s):  
Yi-Ren Chen ◽  
Maxwell Boakye ◽  
Robert T. Arrigo ◽  
Paul S. A. Kalanithi ◽  
Ivan Cheng ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Hospital Stay ◽  
Treatment Modality ◽  
The Elderly ◽  
Morbidity And Mortality ◽  
High Morbidity ◽  
Complication Rates ◽  
Term Survival ◽  
Cord Injury

Abstract BACKGROUND: Closed C2 fractures commonly occur after falls or other trauma in the elderly and are associated with significant morbidity and mortality. Controversy exists as to best treatment practices for these patients. OBJECTIVE: To compare outcomes for elderly patients with closed C2 fractures by treatment modality. METHODS: We retrospectively reviewed 28 surgically and 28 nonsurgically treated cases of closed C2 fractures without spinal cord injury in patients aged 65 years of age or older treated at Stanford Hospital between January 2000 and July 2010. Comorbidities, fracture characteristics, and treatment details were recorded; primary outcomes were 30-day mortality and complication rates; secondary outcomes were length of hospital stay and long-term survival. RESULTS: Surgically treated patients tended to have more severe fractures with larger displacement. Charlson comorbidity scores were similar in both groups. Thirty-day mortality was 3.6% in the surgical group and 7.1% in the nonsurgical group, and the 30-day complication rates were 17.9% and 25.0%, respectively; these differences were not statistically significant. Surgical patients had significantly longer lengths of hospital stay than nonsurgical patients (11.8 days vs 4.4 days). Long-term median survival was not significantly different between groups. CONCLUSION: The 30-day mortality and complication rates in surgically and nonsurgically treated patients were comparable. Elderly patients faced relatively high morbidity and mortality regardless of treatment modality; thus, age alone does not appear to be a contraindication to surgical fixation of C2 fractures.

Adult degenerative scoliosis: evaluation and management

2010 ◽  
Vol 28 (3) ◽  
pp. E1 ◽  
Author(s):  
Fernando E. Silva ◽  
Lawrence G. Lenke
Keyword(s):  
Spinal Fusion ◽  
Mechanical Stability ◽  
Treatment Options ◽  
Posterior Spinal Fusion ◽  
Clinical Analysis ◽  
Complication Rates ◽  
Degenerative Scoliosis ◽  
Anterior Spinal Fusion ◽  
Adult Degenerative Scoliosis

Degenerative scoliosis is a prevalent issue among the aging population. Controversy remains over the role of surgical intervention in patients with this disease. The authors discuss a suitable approach to help guide surgical treatment, including decompression, instrumented posterior spinal fusion, anterior spinal fusion, and osteotomy. These treatment options are based on clinical analysis, radiographic analysis of the mechanical stability of the deformity, given pain generators, and necessary sagittal balance. The high potential complication rates appear to be outweighed by the eventual successful clinical outcomes in patients suitable for operative intervention. This approach has had favorable outcomes and could help resolve the controversy.

The Prevalence of Undiagnosed Presurgical Cognitive Impairment and Its Postsurgical Clinical Impact in Elderly Patients Undergoing Surgery for Adult Spinal Deformity

2017 ◽  
Vol 17 (10) ◽  
pp. S177
Author(s):  
Owoicho Adogwa ◽  
Aladine A. Elsamadicy ◽  
Emily C. Lydon ◽  
Victoria D. Vuong ◽  
Syed I. Khalid ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Elderly Patients ◽  
Spinal Deformity ◽  
Adult Spinal Deformity ◽  
Clinical Impact

scholarly journals Less Invasive Surgical Correction of Adult Degenerative Scoliosis. Part II: Complications and Clinical Outcome

Neurosurgery ◽  
2010 ◽  
Vol 67 (6) ◽  
pp. 1609-1621 ◽  
Author(s):  
Kai-Michael Scheufler ◽  
Donatus Cyron ◽  
Hildegard Dohmen ◽  
Anke Eckardt
Keyword(s):  
Clinical Outcome ◽  
Blood Loss ◽  
Elderly Patients ◽  
Surgical Correction ◽  
Complication Rates ◽  
Intraoperative Blood Loss ◽  
Degenerative Scoliosis ◽  
Less Invasive ◽  
Image Guided ◽  
Functional Scores

Abstract OBJECTIVE: To report on the complication profile and clinical outcomes obtained with less invasive image-guided surgical correction of degenerative (de novo) scoliosis in a high-risk population. METHODS: Thirty patients (age, 64-88 years) with progressive postural impairment, back pain, radiculopathy, and neurogenic claudication caused by degenerative scoliosis were treated by less invasive image-guided correction (3-8 segments) by multisegmental transforaminal lumbar interbody fusion and facet fusions. With a mean follow-up of 19.6 months, intraoperative blood loss, curve correction, fusion and complication rates, duration of hospitalization, incidence of hardware-related problems, and clinical outcome parameters were assessed using multivariate analysis. RESULTS: Satisfactory multiplanar correction was obtained in all patients. Mean intraoperative blood loss was 771.7 ± 231.9 mL, time to full ambulation was 0.8 ± 0.6 days, and length of stay was 8.2 ± 2.9 days. After 12 months, preoperative SF12v2 physical component summary scores (20.2 ± 2.6), visual analog scale scores (7.5 ± 0.8), and Oswestry disability index (57.2 ± 6.9) improved to 34.6 ± 3.9, 2.63 ± 0.6, and 24.8 ± 7.1, respectively. The rate of major and minor complications was 23.4% and 59.9%, respectively. Ninety percent of patients rated treatment success as excellent, good, or fair. CONCLUSION: Less invasive image-guided correction of degenerative scoliosis in elderly patients with significant comorbidity yields a favorable complication profile. Significant improvements in spinal balance, pain, and functional scores mirrored expedited ambulation and early resumption of daily activities. Less invasive techniques appear suitable to reduce periprocedural morbidity, especially in elderly patients and individuals with significant medical risk factors.

scholarly journals Protective effect of dexmedetomidine infusion combined with epidural blockade on postoperative complications after surgery: A prospective randomized controlled clinical trial

2020 ◽  
Vol 48 (6) ◽  
pp. 030006052093016
Author(s):  
Yi Liu ◽  
Xuqin Zhu ◽  
Zhiyong He ◽  
Zhirong Sun ◽  
Xin Wu ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Elderly Patients ◽  
Hospital Stay ◽  
Length Of Hospital Stay ◽  
Radical Resection ◽  
The Other ◽  
Complication Rates ◽  
Epidural Blockade ◽  
Randomized Controlled ◽  
Dexmedetomidine Infusion

Objectives This prospective, randomized, controlled study aimed to explore the efficacy of dexmedetomidine combined with epidural blockade on postoperative recovery of elderly patients after radical resection for colorectal cancer. Methods Ninety-six elderly patients who underwent radical resection for colorectal cancer were randomly divided into the following four groups: dexmedetomidine, epidural blockade (ropivacaine), combined (dexmedetomidine + epidural blockade), and control (0.9% saline). The Mini-Mental State Examination (MMSE), Visual Analog Scale (VAS), and Ramsay scores at 48 hours, and time to first activity, length of hospital stay, and postoperative complication rates at 3 months were assessed. Results Twelve hours after surgery, Ramsay scores were higher in the combined compared with the control and epidural blockade groups. Twenty-four hours after surgery, MMSE scores were higher in the combined compared with the other groups. The combined group showed the lowest VAS scores except at 48 hours. Time to first activity and length of hospital stay were significantly shorter in the combined compared with the other groups. There was no difference in total postoperative complication rates among the groups. Conclusions A combination of intraoperative dexmedetomidine infusion and epidural blockade could mitigate pain after surgery, improve cognitive dysfunction in early surgery, and facilitate recovery.

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