A. Safaya1, A. Zil-E-Ali1, K. So1, F. Aziz1 1Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
Introduction: Patients with a prior history of cognitive impairment or dementia have been shown to have poor surgical outcomes, including increased postoperative morbidity and costs. Although this has been studied in emergency general surgery and trauma, the impact of cognitive impairment or dementia and pre-operative falls has not been specifically reviewed among vascular surgery patients. Endovascular procedures are generally considered low risk. This study's aim was to evaluate outcomes of open and endovascular interventions among patients with cognitive impairment or a history of falls.
Methods: An analysis of the 2021 ACS-NSQIP database was performed, including all patients who underwent various vascular surgical procedures. Patients were stratified based on a previous history of cognitive impairment, dementia, or a fall within the last six months. The study included all patients over 65 years of age undergoing open and endovascular procedures for aortic aneurysmal disease, aorto-iliac occlusive disease, infra-inguinal arterial occlusive disease, and carotid artery stenosis. The primary outcome was 30-day mortality. Secondary outcomes included unplanned readmission, discharge to a non-home facility, and postoperative length of stay (LOS).
Results: A total of 7,057 patients were included in the study, of which 458 (6.5%) had a history of cognitive impairment, dementia, or falls. These patients were found to be older (mean age: 81 ± 6.5 years vs. 74 ± 4 years), more likely to be female (39% vs. 33%), of African American descent (16% vs. 14%), and functionally dependent (35% vs. 5%) compared to those without such a history (all p<0.05). Patients with a history of cognitive impairment, dementia, or falls had a significantly higher risk of 30-day mortality (7.4% vs. 2%; AOR: 2.08 [1.28, 3.37]; p=0.003), return to the operating room (12% vs. 7.7%; AOR: 1.49 [1.06, 2.22]; p=0.023), and non-home discharge (36% vs. 11.4%; AOR: 1.87 [1.67, 1.94]; p<0.001) compared to those without such a history. Additionally, these patients had a longer LOS (mean: 7.4 ± 7 days vs. 4.4 ± 3 days; p<0.001).
Conclusion: Patients undergoing most vascular procedures (both open and endovascular) with a prior history of cognitive impairment, dementia, or a fall within the preceding six months have poorer outcomes, including higher mortality rates. For geriatric patients, early identification of these high-risk cohorts may aid in optimizing pre-operative decision-making, patient and family discussions, and potential prehabilitation strategies to improve the quality of care.