Prospective evaluation of preoperative cognitive impairment and postoperative morbidity in geriatric patients undergoing emergency general surgery

Background: Cognitive impairment (CI) is common in geriatric patients. We aimed to evaluate the prevalence and impact of CI on outcomes in geriatric patients undergoing emergency general surgery (EGS). Methods: We performed a (2017–2018) prospective analysis of patients (age ≥65y) who underwent EGS. Cognition was assessed using the Montreal Cognitive Assessment (MoCA). Patients were stratified into: CI (MoCA score<26) and no-CI (MoCA≥26). Outcomes were the prevalence of CI, in-hospital complications, discharged to rehab/skilled nursing facility (SNF), and mortality. Results: A total of 142 patients were enrolled. Overall prevalence of CI was 20%. Patients with CI had higher rates of complications (OR 1.6 [1.4–1.9]; p = 0.01), and discharge to rehab/SNF (OR 2.2 [2.0–2.5]; p = 0.03). There was no difference in mortality (OR 1.1 [0.6–1.8]; p = 0.24) between the 2 groups. Conclusion: One in five geriatric EGS patients has CI. It is associated with higher complications and adverse discharge. Cognitive assessment should be included in preoperative risk stratification.