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Derivation and Validation of a Risk Stratification System for Predicting Postoperative Cognitive Impairment
Yan Liao1, Xunling Su1, Wen Ouyang1
1Department of Anesthesiology, The Third Xiangya Hospital, Central South University, Changsha, China.
Background:
To establish and validate a risk stratification scoring system (we name it as PreOp-BFS, which represents Pre-Operative Brain Fragility Score) for postoperative cognitive impairment containing postoperative cognitive dysfunction (POCD) and postoperative delirium (POD) in elderly patients undergoing non-cardiac surgery.
Methods:
We searched for relevant literatures and reviews reported in PubMed and ScienceDirect databases from January 1994 to December 2017. We performed a preoperative risk factor for cognitive impairment in elderly patients (age ≥ 60 years) who underwent non-cardiac surgery, and finally constructed a risk scoring system to predict postoperative cognitive impairment.
Results:
The test data included 49 patients with postoperative cognitive impairment and 31 patients without postoperative cognitive impairment. The postoperative risk scale score ranged from 0 to 8 points. The incidence of postoperative cognitive impairment was 16.2%, 62.9% and 96.2% in the low (0-2 scores), medium (3-4 scores) and high (5-8 scores) risk groups, respectively. In addition, the risk of postoperative cognitive impairment was significantly higher in high and medium risk groups than in low risk group. Receiver operating characteristic (ROC) analysis showed that the area under the curve (AUC) of the risk scoring system was 0.862 [95% CI 0.784-0.941].
Conclusions:
The preoperative risk stratification scoring system (PreOp-BFS) established in this study had a good prediction effect, which was helpful for rapid identification and screening of high-risk susceptible patients with early postoperative cognitive impairment, and for performing targeted perioperative prevention.
