Frailty is present in almost half of all older surgical patients. Although frailty has been associated with cognitive decline, this has not been examined in the context of surgery. It is also not known if this relationship is independent of delirium, an established risk factor for postoperative cognitive decline. We probed these questions in the Successful Aging after Elective Surgery cohort of 560 dementia-free older adults (≥70 years old) undergoing elective surgery. Frailty and delirium were measured, respectively, by the Fried Frailty Index and the Confusion Assessment Method supplemented by medical chart review. Postoperative cognitive trajectory was measured as the slope of the General Cognitive Performance (GCP) score, a composite derived from results of a neuropsychological battery administered 2–36 months post-surgery. 64 (12%) of patients were robust, 280 (56%) were pre-frail, and 160 (32%) were frail. Delirium occurred in 134 patients (24%) overall. Compared to the rate of GCP decline among robust patients, decline was steeper by -0.47 points/year (95% CI -0.83, -0.14, p=.005) among pre-frail patients and by -0.48 points/year (95% CI -0.88, -0.07, p=.02) among frail patients. This effect was independent of age, sex, and education. Notably, the known influence of delirium on cognitive decline did not account for the association between frailty and cognitive decline. These results suggest pre-frailty, frailty and delirium are independently associated with accelerated postoperative cognitive decline, with effects of similar magnitude to each other and to mild cognitive impairment. Preoperative frailty screening could identify patients at higher risk of cognitive decline after surgery.
展开▼
机译：几乎所有老年外科手术患者中都存在虚弱。尽管虚弱与认知能力下降有关，但尚未在手术中进行检查。还不知道这种关系是否独立于del妄，,妄是术后认知能力下降的既定危险因素。我们在560名无痴呆的老年人（≥70岁）接受择期手术的择期手术后成功老龄化队列中探讨了这些问题。脆弱和del妄分别通过油炸脆弱指数和医学评估表补充的混淆评估方法进行测量。术后认知轨迹以总体认知表现（GCP）分数的斜率来衡量，该分数是根据术后2至36个月给予神经心理学知识的综合结果得出的。身体虚弱的患者有64名（12％），身体虚弱的有280名（56％），身体虚弱的有160名（32％）。总共有134例患者（24％）发生妄。与健壮患者的GCP下降率相比，体弱的患者下降幅度为-0.47点/年（95％CI -0.83，-0.14，p = .005），下降幅度为-0.48点/年（95％） CI -0.88，-0.07，p = .02）。此效果与年龄，性别和教育程度无关。值得注意的是，of妄对认知能力下降的已知影响并未说明脆弱与认知能力下降之间的关联。这些结果表明，虚弱前，虚弱和del妄与术后加速的认知能力下降独立相关，彼此之间的影响程度相似，并且与轻度认知障碍有关。术前虚弱筛查可以识别出术后认知功能下降风险较高的患者。
展开▼
