Medical Student University of Cincinnati University of Cincinnati
Introduction: Mild cognitive impairment (MCI) and dementia are recognized as independent risk factors for postoperative complications following spine surgery. However, no comprehensive systematic review has yet examined the impact of cognitive impairment (CI) on spine surgery outcomes. The aim of this study is to perform a systematic review and meta-analysis of existing research on perioperative outcomes in patients with cognitive impairment undergoing spine surgery.
Methods: A systematic search of PubMed, Embase, Cochrane Library, and Web of Science was conducted on July 8th, 2024. Studies directly comparing spine surgery outcomes in cognitively impaired populations versus normal cognition were included for meta-analysis. Studies discovering cognitive impairment as a risk factor secondarily associated with an analyzed variable were included for review only. Data on postoperative outcomes including delirium, urinary tract infection, myocardial infarction, ileus, pulmonary embolism, deep vein thrombosis, pneumonia, surgical site infection, wound dehiscence, sepsis, acute kidney injury, neurological complications, reoperation, readmission, intensive care unit admission, length of stay, discharge location, and cost were assessed.
Results: A total of 1,074 articles were screened by title and abstract, leading to 66 studies being selected for full-text review, and 31 articles meeting the inclusion criteria for this study. Of these, 13 studies (eight retrospective cohort studies and five prospective observational studies) directly evaluated the impact of cognitive impairment (CI) on spine surgery outcomes. Meta-analysis using a random-effects model indicated that patients with CI had significantly higher odds of postoperative complications, including urinary tract infection (UTI) (OR 4.32 [2.24–8.33]), delirium (OR 2.51 [1.69–3.72]), deep vein thrombosis (DVT) (OR 2.49 [1.23–5.03]), pneumonia (OR 3.24 [1.94–5.43]), wound dehiscence (OR 1.50 [1.08–2.08]), sepsis (OR 2.18 [1.04–4.56]), intensive care unit (ICU) admission (OR 2.05 [1.22–3.44]), readmission (OR 1.22 [1.07–1.39]), and reduced likelihood of home discharge (OR 0.29 [0.26–0.32]) following spine surgery.
Conclusion : This study indicates that preoperative cognitive impairment (CI) is associated with poorer postoperative health outcomes and suboptimal facility-based measures in patients undergoing spine surgery. These results underscore the importance of early identification and management of CI before spine surgery.
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