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A Preoperative Cognitive Screening Test Predicts Increased Length of Stay in a Frail Population: A Retrospective Case–Control Study

O’Reilly-Shah, Vikas N. MD, PhD*,†; Hemani, Salman MD*; Davari, Paran BS; Glowka, Lena BS*; Gebhardt, Emily MSPH§; Hill, Laureen MD, MBA; Lee, Simon MD*; Master, Viraj A. MD, PhD; Rodriguez, Amy D. PhD#; García, Paul S. MD, PhD*,‖,#

doi: 10.1213/ANE.0000000000004103
Patient Safety: Original Clinical Research Report

BACKGROUND: Frailty is associated with adverse perioperative outcomes including major morbidity, mortality, and increased length of stay. We sought to elucidate the role that a preoperatively assessed Mini-Cog can play in assessing the risk of adverse perioperative outcomes in a population at high risk of frailty.

METHODS: In this retrospective case–control study, patients who were >60 years of age, nonambulatory, or had >5 documented medications were preoperatively assessed for handgrip strength, walking speed, and Mini-Cog score. The Emory University Clinical Data Warehouse was then used to extract this information and other perioperative data elements and outcomes data.

RESULTS: Data were available for 1132 patients undergoing a wide variety of surgical procedures. For the subset of 747 patients with data for observed-to-expected length of stay, an abnormal Mini-Cog was associated with an increased odds of observed-to-expected >1 (odds ratio, 1.52; 95% CI, 1.05–2.19; P = .025). There was no association of abnormal Mini-Cog with intensive care unit length of stay >3 days (P = .182) discharge to home with self-care (P = .873) or risk of readmission (P = .104). Decreased baseline hemoglobin was associated with increased risk of 2 of the 4 outcomes studied.

CONCLUSIONS: In a high-risk pool of patients, Mini-Cog may not be sensitive enough to detect significant differences for most adverse outcomes. Further work is needed to assess whether cognitive screens with greater resolution are of value in this context and to compare tools for assessing overall frailty status.

From the *Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia

Division of Pediatric Anesthesiology, Children’s Healthcare of Atlanta, Atlanta, Georgia

University of Kentucky College of Medicine, Lexington, Kentucky

§Emory University Rollins School of Public Health, Druid Hills, Georgia

New York-Presbyterian/Columbia University, New York City, New York

Department of Urology, Emory University School of Medicine, Atlanta, Georgia

#Veteran Affairs Rehabilitation Research and Development Center for Visual and Neurocognitive Rehabilitation, Atlanta Veterans Affairs Healthcare System, Decatur, Georgia.

Published ahead of print 28 January 2019.

Accepted for publication January 28, 2019.

Funding: This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. This work was supported by the Emory University Department of Anesthesiology. V.N.O.-S.’s research efforts are supported by a Woodruff Health Sciences Center Synergy Grant. P.S.G.’s research efforts are supported by a Veterans Affairs Career Development Award #BX00167 and a James S. McDonnell Foundation Grant #220023046.

The authors declare no conflicts of interest.

Reprints will not be available from the authors.

Address correspondence to Paul S. García, MD, PhD, Department of Anesthesiology, Neuroanesthesia Division, Columbia University Medical Center, New York Presbyterian Hospital – Irving, New York City, NY. Address e-mail to

Copyright © 2019 International Anesthesia Research Society
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