Adverse postoperative outcomes in geriatric population with a history of cognitive impairment or falls undergoing vascular surgery.

Abstract

We assessed the association of preoperative cognitive impairment/dementia (CI/D) and recent fall history with 30-day postoperative outcomes in patients aged greater than 65 years undergoing vascular surgery. The American College of Surgeons National Surgical Quality Improvement Program was queried for vascular surgery patients aged greater than 65 years in 2021, the first year CI/D and fall history were captured. Patients were categorized into two groups: those without CI/D or falls (group I) and those with either or both (group II). Outcomes included 30-day mortality, unplanned return to operating room, nonhome discharge, and length of stay. Multivariable logistic regression was used to identify independent associations, adjusting for demographic and clinical covariates. Among 7057 patients, 458 (6.5%) had CI/D or fall history. Compared with group I, group II patients were older (81.7 years vs 74.3 years), more likely to be functionally dependent (34.7% vs 5.4%), and had a greater comorbidity burden. Group II experienced significantly worse outcomes: 30-day mortality (7.4% vs 2.1%), return to operating room (12.0% vs 7.7%), and nonhome discharge (35.6% vs 11.0%) (all P < .001). On adjusted analysis, CI/D or falls were independently associated with increased odds of mortality (adjusted odds ratio [AOR], 2.08; 95% confidence interval [CI], 1.28-3.37), return to operating room (AOR, 1.49; 95% CI, 1.06-2.22), and nonhome discharge (AOR, 2.28; 95% CI, 1.77-2.93). Isolated CI/D was associated with mortality (AOR, 2.26; 95% CI, 1.14-4.51), and falls alone were associated with return to the operating room (AOR, 1.62; 95% CI, 1.04-2.52) and nonhome discharge (AOR, 2.89; 95% CI, 2.09-3.99). In geriatric vascular surgery patients, preoperative CI/D and falls are significant, independent predictors of postoperative mortality and morbidity. These readily identifiable clinical features should be incorporated into preoperative risk assessments to improve surgical decision-making and resource allocation.