Among individuals with “significant vascular surgical pathology,” John Houghton (University of Leicester, Leicester, UK) and colleagues have found that the prevalence of cognitive impairment is high and is associated with worse postoperative delirium (POD). Therefore, they suggest that screening elective vascular surgery patients for cognitive impairment “may be appropriate”.
These conclusions are based on the findings of a systematic review and meta-analysis that was recently published online in the European Journal of Vascular and Endovascular Surgery (EJVES).
Prior to this study, Houghton et al write that the true prevalence of undiagnosed cognitive impairment on vascular surgery patients and its impact on outcomes were “unknown,” prompting the research team to conduct the present study.
The investigators detail that they searched MEDLINE, EMBASE, EMCare, CINAHM, PsycINFO, and Scopus databases for relevant studies. To be included, studies had to have assessed cognitive function among individuals with either symptomatic vascular surgical pathology, or disease above the threshold for intervention, they write.
Houghton and colleagues included 24 studies—comprising 2,564 patients—in the systematic review, and nine studies—involving 1,310 patients—in the meta-analysis. The primary outcome measure was prevalence of cognitive impairment, and secondary outcomes included incidence of POD.
Writing in EJVES, the authors report that the prevalence of cognitive impairment, measured using the Montreal cognitive assessment, was 61% (95% confidence interval [CI] 48–74%; 391 participants) in patients undergoing major vascular surgery, and 38% (95% CI 32–44%; 278 participants) in those with significant carotid artery disease.
Finally, Houghton et al relay that lower cognitive assessment scores were associated with POD (five studies; 841 participants), but stress that data were not suitable for pooling in this category.