Prediction of Postoperative Cognitive Impairment. Ensuring Patient Safety with a Validated Structured Assessment

This article refers to:

Derivation and Validation of a Risk Stratification System for Predicting Postoperative Cognitive Impairment

Ensuring demand-oriented health care requires target-group-specific treatment modalities. The identification of demand adequacy is usually carried out by the employees of the daily care and is considered as the gold standard [1]. Scientifically developed assessments of selected care intersections help to systematically record patient characteristics and derive measures for further treatment [2]. With structured assessments, transparent and traceable documentation is also possible for measuring the severity of illness, recording treatment data, it is helpful for patient transfers or shift handovers. There are a large number of assessments depending on the medical specialty and for the corresponding indication. Probably the best-known assessments in nursing are the patient-specific risk assessment of pressure ulcers and fall prevention.

For patients of all ages, surgical interventions are a burden on their state of health and a restriction on their quality of life. For patients with a high age or other risk factors [3], surgical interventions can have medium to long-term consequences on their quality of life. Impaired mental performance can occur in patients of any age after serious diseases requiring intensive treatment. These manifest themselves in acute or delayed cognitive deficits and are frequent complications in everyday clinical practice during intensive care treatment [4]. Especially during intensive care treatment of elderly patients after surgical interventions, postoperative delirium (POD) or postoperative cognitive dysfunction (POCD) could be manifested and state as a negative result. The consequences can be difficult mobilization, resulting decubital ulcers, pneumonia or venous thrombosis. All these consequences amount to an extension of the inpatient stay and reduce the postoperative independence of the patient. The early identification of the patient clientele with increased risk is of major importance in order to plan pre- and postoperative processes, ensure that care is appropriate and to be able to act preventively.

A standardized and validated test procedure to identify patients with corresponding risk factors of postoperative cognitive impairment was missing until now. In fact, a number of tests for each patient were available to verify individual risk factors [5]. With the help of the present assessment [6] for patients with non-cardiac surgical interventions, it is possible to prospectively determine the postoperative risk of cognitive impairment using five content-classified items. The approach of this assessment is practice-oriented and pragmatic. Using a score, patients with and without risk of postoperative cognitive impairment can be reliably differentiated. The assessment has been tested and piloted in various surgical departments, such as orthopedics, gynecology and general surgery, and is also used there. The reliability of the procedure is in a very good range for a clinical test with an AUROC above 85% [6].

In ensuring high quality of health care, validated test procedures are an effective means of providing early and correct information about the needs of individual patients in a complex process organization. The experience and evidence of the medical experts involved in care can thus be usefully supplemented. The combination of internal and external evidence can be expanded with the help of assessments, so that the patient-specific need for care is made sufficient and appropriate.

Disclosure statement

No potential conflict of interest was reported by the author(s).