Preoperative frailty vs. cognitive impairment: Which one matters most for postoperative delirium among older adults with cancer? Journal Article


Authors: Hoffmann, A. J.; Tin, A. L.; Vickers, A. J.; Shahrokni, A.
Article Title: Preoperative frailty vs. cognitive impairment: Which one matters most for postoperative delirium among older adults with cancer?
Abstract: Introduction: Limited data are available to explore the association between preoperative frailty and cognitive impairment with postoperative delirium among older adults with cancer. We explored this association in a single Comprehensive Cancer Center where postoperative delirium and frailty are assessed in routine care using the Confusion Assessment Method (CAM) and Memorial Sloan Kettering Frailty Index (MSK-FI), respectively. Materials and Methods: Retrospective study on patients with cancer, aged 65+, who underwent surgery from April 2018 to March 2019 with hospital stay ≥1 day. We used logistic regression with postoperative delirium as the outcome, primary predictor MSK-FI, adjusted for age, operative time, and preoperative albumin. As the MSK-FI includes a component related to cognitive impairment, we additionally evaluated the impact of this component, separately from the rest of the score, on the association between frailty and postoperative delirium. Results: Among 1,257 patients with available MSK-FI and CAM measures, 47 patients (3.7%) had postoperative delirium. Increased frailty was associated with increased risk of postoperative delirium (odds ratio [OR] 1.51; 95% confidence interval [CI] 1.26, 1.81; p < 0.001). However, this was largely related to the effect of cognitive impairment (OR 15.29; 95% CI 7.18; 32.56; p < 0.001). In patients with cognitive impairment, the association between frailty and postoperative delirium was not significant (OR 0.97; 95% CI 0.65, 1.44; p-value = 0.9), as having cognitive impairment put patients at high risk for postoperative delirium even without taking into account the other components of the MSK-FI. While the association between frailty and postoperative delirium in patients with intact cognitive function was statistically significant (OR 1.58; 95% CI 1.27, 1.96; p < 0.001), it was not clinically meaningful, particularly considering the low risk of delirium among patients with intact cognitive function (e.g., 1.3% vs 3.2% for MSK-FI 1 vs 3). Discussion: Cognitive function should be a greater focus than frailty, as measured by the MSK-FI, in preoperative assessment for the prediction of postoperative delirium. © 2023 Elsevier Ltd
Keywords: controlled study; aged; major clinical study; cancer patient; disease association; clinical assessment; delirium; cohort analysis; retrospective study; prediction; groups by age; high risk patient; hospitalization; albumin; operation duration; clinical evaluation; surgical risk; cognition; aging; cognitive defect; cognitive impairment; geriatric oncology; low risk patient; frailty; postoperative delirium; human; male; female; article; preoperative complication; population structure
Journal Title: Journal of Geriatric Oncology
Volume: 14
Issue: 4
ISSN: 1879-4068
Publisher: Elsevier Inc.  
Date Published: 2023-05-01
Start Page: 101479
Language: English
DOI: 10.1016/j.jgo.2023.101479
PUBMED: 37001348
PROVIDER: scopus
PMCID: PMC10530636
DOI/URL:
Notes: Article -- MSK Cancer Center Support Grant (P30 CA008748) acknowledged in PDF and PubMed -- MSK corresponding author is Armin Shahrokni -- Export Date: 1 May 2023 -- Source: Scopus
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MSK Authors
  1. Andrew J Vickers
    887 Vickers
  2. Armin Shahrokni
    133 Shahrokni
  3. Amy Lam Ling Tin
    116 Tin