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http://dx.doi.org/10.3340/jkns.2016.59.3.287
Print ISSN 2005-3711 On-line ISSN 1598-7876
Copyright © 2016 The Korean Neurosurgical Society
J Korean Neurosurg Soc 59 (3) : 287-291, 2016
Clinical Article
The Prevalence of Undiagnosed Presurgical Cognitive Impairment and Its Postsurgical Clinical Impact in Older Patients Undergoing Lumbar Spine Surgery Young-Seok Lee, M.D.,1 Young-Baeg Kim, M.D., Ph.D.,2 Shin-Heon Lee, M.D.,2 Yong-Sook Park, M.D., Ph.D.,2 Seung-Won Park, M.D., Ph.D.2 Department of Neurological Surgery,1 Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea Department of Neurosurgery,2 Chung-Ang University College of Medicine, Seoul, Korea Objective : Because elderly patients are undergoing more surgeries, the importance of postoperative cognitive impairment (CI) evaluations is rising, especially for spine surgery, which is related to subjective pain. We investigated the prevalence of undiagnosed CI among elderly patients who underwent spine surgery and the impact of CI on postoperative outcomes. Methods : The preoperative cognitive statuses of 129 patients over 65 who underwent lumbar spine surgery from 2012 to 2014 were determined with the Mini-Mental State Examination, and patients with scores under 24 were diagnosed with CI. The patients were then divided into a CI group (n=49) and non-cognitive impairment (NCI) group (n=80). Results : Among the 129 patients, 49 (38.0%) were diagnosed with CI, and 9 (7.0%) had severe CI. The age of the CI group (72.88±6.20 years) was significantly greater than that of the NCI group (69.96±4.53 years). In contrast, the postoperative visual analog scale scores and performance statuses did not differ significantly. However, postoperative delirium was more frequent and the hospital stay length was longer in the CI group compared with the NCI group (p0.05) (Table 2). We investigated the comorbid conditions prior to surgery. Although we found a number of conditions, such as hypertension, cardiovascular disease, diabetes mellitus, asthma, renal disease, and cancer, there were no statistically significant differences between the CI group and the NCI group. Preoperative ECOG performance status, presurgical medication, surgical method, and laboratory abnormalities did not differ between Table 1. Prevalence of cognitive impairment Cognitive impairmeut Non-diagnosed cognitive impairment Mild cognitive impairment Severe cognitive impairment
288
n (total=49) Prevalence (%) 49 40 9
38.0 31.0 7.0
Cognitive Impairment before Spine Surgery in Elderly Patients | YS Lee, et al.
the groups (p>0.05). The time from hospital admission to the start of surgery was 4.59±4.59 days for the CI group and 3.82± 7.01 days for the NCI group, which again showed no statistically significant difference (p>0.05). Table 2. Patient characteristics CI group (n=49)
NCI group (n=80)
p value
Age (years)
72.88±6.20
69.96±4.53
0.005
Sex (M : F)
14 : 35
37 : 43
0.063
49
79
Smoking
5/44
14/66
0.313
Alcohol
6/43
18/62
0.169
31
53
0.205
3
10
Characteristics
Marital status
1
Comorbid conditions Hypertension Cardiovascular disease Diabetes mellitus
22
21
Asthma
9
5
Renal disease
2
3
Cancer
3
5
12
1
11
VAS
6.82±1.20
6.70±0.83
0.191
Preoperative ECOG performance (0/I/II/III)
1/21/20/7
0/45/27/8
0.309
NSAID
34
66
0.864
Tramadol
30
43
4
8
11
20
1
2
PHLD
1
4
PSF
6
7
TLIF
24
38
DLIF
17
29
OLIF
3
5
Education background (years) 0.001
Preadmission medication
Opioid Gabapentin Steroid
DISCUSSION
Surgical type 0.886
Laboratory abnormality Hematocrit 20
7
14
0.807
WBC count >12000
3
2
0.367
Sodium 0.05). We investigated the length of stay for the CI group (19.59±15.37 days) and NCI group (10.37±8.71 days) and found a statistically significant difference and (p
