The association between preoperative Mini-Cog© score and postoperative delirium (POD): a retrospective cohort study

The onset of delirium after major surgery is associated with worse in-hospital outcomes for major surgical patients. Best practice recommends assessing surgical patients for delirium risk factors and this includes screening for cognitive impairment. The Mini-Cog© is a short instrument which has been shown to predict postoperative delirium (POD) and other complications in elderly patients undergoing major elective surgery. The primary aim of this study was to ascertain whether a positive preoperative Mini-Cog© is associated with postoperative delirium in elective colorectal surgery patients at high-risk of mortality due to age or comorbidity. Secondary outcomes were 90-day mortality and length of stay.

This is a retrospective analysis of data gathered prospectively between October 2015 and December 2017. Baseline data were collected at a preoperative screening clinic, and postoperative data during daily ward rounds by the Perioperative Medicine team at The York Hospital.

Three hundred nineteen patients were included in the final analysis, of which 52 (16%) were found to be cognitively impaired on the Mini-Cog©. Older patients (median difference 10 years, p < 0.001) and patients with cognitive impairment (OR 3.04, 95%CI 1.15 to 8.03, p = 0.019) were more likely to develop postoperative delirium in univariate analysis; however, cognitive impairment (OR 0.492, 95%CI 0.177 to 1.368, p = 0.174) loses its significance when controlled for by confounding factors in a logistic regression model. Cognitive impairment (OR 4.65, 95%CI 1.36 to 15.9, p = 0.02), frailty (OR 7.28, 95%CI 1.92 to 27.58, p = 0.009), American Society of Anesthesiologists (ASA) grade (OR 5.95, 95%CI 1.54 to 22.94, p = 0.006) and age (median difference 10 years, p = 0.002) were significantly associated with 90-day mortality in univariate analysis. Sex was the only factor significantly associated with length of stay in the multiple regression model, with males having a 3-day longer average length of stay than females (OR = 2.94, 95%CI 0.10-5.78).

Mini-Cog© is not independently associated with post-operative delirium in high-risk elective colorectal surgery patients in this cohort. Mini-Cog© shows promise as a possible predictor of 90-day mortality. Larger studies exploring preoperative cognitive status and postoperative confusion and mortality could improve risk-stratification for surgery and allocation of resources to those patients at higher risk.