Surgical Complications in Older Adults Predict Decline in Self-Perceived Cognitive Function in the Ensuing Year: A Cohort Study

Abstract

Background: Surgical complications are common among older adults and are potential indicators of poorer long-term outcomes. The authors examined the effects of in-hospital complications on changes in older adults’ self-perceived cognitive function in the year after surgery. Method: The authors conducted a prospective longitudinal study with 2,155 older adults (age ≥ 65) undergoing surgery, investigating the association between self-reported, in-hospital complications after surgery and Patient-Reported Outcomes Measurement Information System Applied Cognition-Abilities survey (4 items, cognitive function) at 30 days and 1 year after surgery. Surveys were scored on a continuous scale of 0–100, with higher scores representing better self-perceived cognitive functioning. Patient characteristics including demographics, type of complications, surgery type, pain, and activities of daily living were also collected. Results: Having one in-hospital complication was associated with a decrease of 1.79 points (95% confidence interval (CI): −2.78, −0.80), indicating lower self-perceived cognitive functioning at 1 year after surgery; having two or more in-hospital complications was associated with 2.82 point (95% CI: −4.50, −1.15) decrease at 1 year after surgery. Models specific to complication type indicated that respiratory [−3.04, (95% CI: −5.50, −0.57)], neural [−2.11, (95% CI: −3.97, −0.25)], and general complications [−2.39, (95% CI: −3.51, −1.28)] were associated with statistically significant decreases in cognitive function. Discussion: Older surgical patients who suffer in-hospital complications show greater decline in self-perceived cognitive function during the ensuing year. Geriatric specialists may be able to intervene in the immediate perioperative period to reduce complications and possibly mitigate cognitive decline among older adults.