Preoperative Cognitive Stratification of Older Elective Surgical Patients: A Cross-Sectional Study

Deborah J. Culley, Devon Flaherty, Srini Reddy, Margaret C. Fahey, James Rudolph, Chuan Chin Huang, Xiaoxia Liu, Zhongcong Xie, Angela M. Bader, Bradley T. Hyman, Deborah Blacker, Gregory Crosby

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66 Scopus citations


BACKGROUND: Preexisting cognitive impairment is emerging as a predictor of poor postoperative outcomes in seniors. We hypothesized that preoperative cognitive screening can be performed in a busy preadmission evaluation center and that cognitive impairment is prevalent in elective geriatric surgical patients. METHODS: We approached 311 patients aged 65 years and older presenting for preoperative evaluation before elective surgery in a prospective, observational, single-center study. Forty-eight patients were ineligible, and 63 declined. The remaining 200 were randomly assigned to the Mini-Cog (N =100) or Clock-in-The-Box [CIB; N = 100)] test. Study staff administered the test in a quiet room, and 2 investigators scored the tests independently. Probable cognitive impairment was defined as a Mini-Cog ≤ 2 or a CIB ≤ 5. RESULTS: The age of consenting patients was 73.7 ± 6.4 (mean ± SD) years. There were no significant differences between patients randomly assigned to the Mini-Cog and CIB test in age, weight, gender, education, ASA physical status, or Charlston Index. Overall, 23% of patients met criteria for probable cognitive impairment, and prevalence was virtually identical regardless of the test used; 22% screened with the Mini-Cog and 23% screened with the CIB scored as having probable cognitive impairment (P = 1.0 by χ2 analysis). Both tests had good interrater reliability (Krippendroff = 0.86 [0.72-0.93] for Mini-Cog and 11 for CIB). CONCLUSIONS: Preoperative cognitive screening is feasible in most geriatric elective surgical patients and reveals a substantial prevalence of probable cognitive impairment in this population.

Original languageEnglish
Pages (from-to)186-192
Number of pages7
JournalAnesthesia and Analgesia
Issue number1
StatePublished - 1 Jul 2016
Externally publishedYes


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