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Maheshwari K, Yalcin EK, Wang D, Mascha EJ, Rosenfeldt A, Alberts JL, Turan A, Sessler DI, Cummings Iii KC: Processing speed test and 30-day readmission in elderly non-cardiac surgery patients- A retrospective study. Ind J Anaesth 2023; 67: 620-627

July 14, 2023

Background and Aims:
Preoperative cognitive function screening can help identify high‑risk patients, but resource‑intensive testing limits its widespread use. A novel self‑administered tablet computer‑based Processing Speed Test (PST) was used to assess cognitive “executive” function in non‑cardiac surgery patients, but the relationship between preoperative test scores and postoperative outcomes is unclear. The primary outcome was a composite of 30‑day readmission/death. The secondary outcome was a collapsed composite of discharge to a long‑term care facility/death. Exploratory outcomes were 1) time to discharge alive, 2) 1‑year mortality and 3) a collapsed composite of postoperative complications.
Methods:
This retrospective study, after approval, was conducted in elective non‑cardiac surgery patients ≥65 years old. We assessed the relationship between processing speed test scores and primary/secondary outcomes using multivariable logistic regression, adjusting for potential confounding variables.
Results: Overall 1568 patients completed the PST, and the mean ± standard deviation test score was 33 ± 10. The higher PST score is associated with better executive function. A 10‑unit increase in the test score was associated with an estimated 19% lower 30‑day readmission/death odds, with an odds ratio (OR) and 95% confidence interval (CI) of 0.81 (0.68, 0.96) (P = 0.015). Similarly, 10‑unit increase in test score was associated with an estimated 26% lower odds of long‑term care need/death, with OR (95% CI) of 0.74 (0.61, 0.91) (P = 0.004). We also found statistically significant associations between the test scores and time to discharge alive and to 1‑year mortality, however, not with a composite of postoperative complications.
Conclusion:
Elderly non‑cardiac surgery patients with better PST scores were less likely to be readmitted, need long‑term care after discharge or die within 30 days. Preoperative assessment of cognitive function using a simple self‑administered test is feasible and may guide perioperative care.
Key words: Cognition, processing speed test, readmission, non‑cardiac surgery