The effect of cognitive dysfunction on mid- and long-term mortality after vascular surgery

András Szabó, Krisztina Tóth, Ádám Nagy, Dominika Domokos, Nikoletta Czobor, Csaba Eke, Ágnes Sándor, Béla Merkely, Éva Susánszky, János Gál, Andrea Székely, András Szabó, Krisztina Tóth, Ádám Nagy, Dominika Domokos, Nikoletta Czobor, Csaba Eke, Ágnes Sándor, Béla Merkely, Éva Susánszky, János Gál, Andrea Székely

Abstract

Background: In recent decades, previous studies have noted the importance of frailty, which is a frequently used term in perioperative risk evaluations. Psychological and socioeconomical domains were investigated as part of frailty syndrome. The aim of this study was to assess the importance of these factors in mortality after vascular surgery.

Methods: In our prospective, observational study (ClinicalTrials.gov Identifier: NCT02224222), we examined 164 patients who underwent elective vascular surgery between 2014 and 2017. At the outpatient anaesthesiology clinic, patients completed a questionnaire about cognitive functions, depression and anxiety, social support and self-reported quality of life were assessed using a comprehensive frailty index, in addition to medical variables. Propensity score matching was performed to analyse the difference between patients and controls in a nationwide population cohort. The primary outcome was 4 year mortality. The Kaplan-Meier method and Cox regression analysis were used for statistical analyses.

Results: The patients' mean age was 67.05 years (SD: 9.49 years). Mini-Mental State Examination scores of less than 27 points were recorded for 41 patients. Overall mortality rates were 22.4 and 47.6% in the control and cognitive impairment groups, respectively (p = 0.013). In the univariate Cox regression analysis, cognitive impairment measured using age- and education-adjusted MMSE scores increased the risk of mortality (AHR: 2.842, 95% CI: 1.389-5.815, p = 0.004).

Conclusion: Even mild cognitive dysfunction measured preoperatively using the MMSE represents a potentially important risk factor for mortality after vascular surgery.

Keywords: Cognitive dysfunction; Mini mental state examination; Perioperative risk factors; Psychosocial factors; Social support; Vascular surgery.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
KM curve for MMSE categories and mortality: a. MMSE groups: 27 points and higher, 24–26 points, 23 points and lower. b. MMSE groups: age and education adjusted normal cognitive function and cognitive impairment. c. MMSE groups: 27 points and higher, 26 points and lower (modified cut-off value). Legend: In Fig. 1/A log-rank pairwise comparison was performed: an MMSE score of 27 points or higher vs. 24–26 points, p = 0.531; 27 points or higher vs. 23 or fewer points, p = 0.007; 24–26 points and 23 points and below, p = 0.120
Fig. 2
Fig. 2
Effects of variables on overall mortality in the multivariate Cox regression model

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