The Significance of Preoperative Impaired Sensorium on Surgical Outcomes in Nonemergent General Surgical Operations

ImportanceWith an aging population, preoperative assessment of the frail older adult requires evaluation beyond simply accounting for chronic diseases. Impaired cognition is a recognized characteristic of the frail older adult.ObjectiveTo examine the effect of preoperative impaired sensorium (IS) on general surgical outcomes.Design, Setting, and ParticipantsRetrospective cohort study using data between January 2005 and December 2010 at academic and community hospitals participating in the American College of Surgeons National Surgical Quality Improvement Program. Patients undergoing nonemergent general surgical operations were studied. Multivariable logistic regression involving 45 preoperative patient-level risk factors and comorbidities was used to calculate the conditional probability of having IS. Patients having and not having preoperative IS were matched on their propensity scores using a 1:1 greedy matching technique. Propensity score matching resulted in almost all (n = 1765) patients with IS uniquely matching to a patient without IS, resulting in a cohort size of 3530. Complication rates between patients with and without IS were compared.Main Outcomes and MeasuresRates of postoperative complications and death following nonemergent general surgical operations.ResultsIn total, 294 037 patients were studied, of whom 1771 (0.6%) had preoperative IS. Patients with IS were older and had more significant preoperative risk factors and comorbidities. As a result, unadju...
Source: JAMA Surgery - Category: Sports Medicine Source Type: research