Does Comprehensive Geriatric Assessment Reduce the Incidence of Postoperative Delirium? A Quasi-experimental Study in Older Adults Undergoing Transcatheter Aortic Valve Implantation

Abstract

Purpose

Postoperative delirium (POD) after transcatheter aortic valve implantation (TAVI) is frequent in older adults and associated with multiple negative outcomes including a higher mortality. We aimed to investigate whether a comprehensive geriatric assessment (CGA) prior to TAVI reduces the odds of POD and results in a positive change in self-care ability, intended to lay a foundation for future geriatric comanagement.

Patients and methods

We used a retrospective, single-center study with a quasi-experimental design enrolling patients aged 70 years and older undergoing CGA before elective TAVI, and a nonrandomized comparison group without preoperative CGA. Data on POD occurrence during the first 5 days after TAVI (primary outcome) and change in self-care ability index (SPI) between admission and discharge (secondary outcome) were collected from electronic health records and CGA data (exposure) by clinical assessment. To explore associations between (1) CGA and POD, and (2) CGA and SPI, multivariate logistic regression and linear regression models were applied adjusting for age, sex, BMI, and number of medications.

Results

Among 435 patients (mean age 81.0 ± 5.6 years, 43.6% women, median [IQR] SPI at baseline 40 [39, 40] points), POD incidence was 14.3% in the CGA group vs 18.8% in the non-CGA group (P 0.219). Undergoing CGA before TAVI was not associated with the odds for POD (OR: 1.15; 95%CI: 0.65–2.04) or improved SPI (P 0.073).

Conclusion

We observed no association of CGA prior to TAVI with POD incidence or postoperative self-care, highlighting the need for additional studies investigating the effect of POD preventive measures in older TAVI patients integrated into a comprehensive geriatric comanagement program.

Keywords:

• POPS
• frail older adults
• perioperative care
• aortic stenosis
• TAVI
• delirium

Abbreviations

ADL, activities of daily living; AS, aortic stenosis; BASEC, Business Administration System for Ethics Committees; CAM, confusion assessment method; CEPD, cerebral embolic protection device; CGA, comprehensive geriatric assessment; DOS, Delirium Observation Screening Scale; DSM-IV, Diagnostic and Statistical Manual of Mental Disorders IV; ICDSC, Intensive Care Delirium Screening Checklist; ICU, intensive care unit; MMSE, Mini-mental State Examination; POD, postoperative delirium; POPS, proactive care of older patients undergoing surgery; SAVR, surgical aortic valve replacement; SPI, self-care ability index (German “Selbstpflegeindex”); SPPB, short physical performance battery; TAVI, transcatheter aortic valve implantation; USZ, University Hospital Zurich.

Disclosure

LTT is currently an employee of Nestlé SA Research, Lausanne, Switzerland. All the other authors have no competing interest in this work.