Preoperative cognitive impairment and postoperative delirium among Holocaust survivors who achieved longevity

Yotam Weiss; Shiri Zarour; Yossef Kiselevich; Maher Abu Ghanim; Daniel Hikry; Isaac Sinai Brzezinski; Lilach Zac; Barak Cohen; Idit Matot

doi:10.1111/jgs.18836

Preoperative cognitive impairment and postoperative delirium among Holocaust survivors who achieved longevity

J Am Geriatr Soc. 2024 Mar 14. doi: 10.1111/jgs.18836. Online ahead of print.

Authors

Yotam Weiss¹, Shiri Zarour¹, Yossef Kiselevich¹, Maher Abu Ghanim¹, Daniel Hikry¹, Isaac Sinai Brzezinski¹, Lilach Zac¹, Barak Cohen^{1

2}, Idit Matot¹

Affiliations

¹ Division of Anesthesia, Intensive Care, and Pain Management, Tel-Aviv Medical Center, Tel-Aviv University, Tel-Aviv, Israel.
² Outcomes Research Consortium, Cleveland Clinic, Cleveland, Ohio, USA.

PMID: 38485466
DOI: 10.1111/jgs.18836

Abstract

Background: Holocaust survivors (HS) experience higher rates of physiological and psychological morbidities, increasing their vulnerability to perioperative complications. Limited information exists regarding their perioperative neurocognitive disorders. This study aimed to assess the rates of preoperative cognitive impairment, postoperative delirium, and other complications among HS aged 75+ undergoing elective surgery.

Methods: This is a single-center retrospective cohort study that analyzed prospectively collected data. All surgical patients born before 1945 who underwent elective noncardiac surgery at a tertiary hospital in Israel during 2020-2021 were included. The HS group was identified through the hospital's information system. Preoperative cognitive impairment was assessed using the Mini-Cog test. Postoperative delirium was defined as a combined outcome, which included a positive 4A's-Test (4AT) result during the postanesthesia care unit stay up to the second postoperative day, a positive 3-Minute Diagnostic Confusion Assessment Method (3D-CAM) test administered by the geriatric team, and identification through the medical records using the Chart-based Delirium Identification Instrument (CHART-DEL). We used multivariable regression to assess the risk factors for postoperative delirium.

Results: Out of 1332 eligible patients, 422 (32%) were HS, while the others served as controls. Both groups had a similar rate of preoperative cognitive impairment (24%, p = 0.89) and postoperative delirium (16%, p = 0.95). HS exhibited a higher risk of the composite adverse events (24% vs. 20%, p = 0.05, aOR [95% CI] 1.3 [1.0-1.7]), driven mainly by falls during hospitalization (4% vs. 2%, p = 0.03, aOR 2.1 [1.1-4.1]). HS patients were more likely to be childless (33% vs. 11%, p = 0.001) and had higher rates of chronic antidepressant and benzodiazepine use.

Conclusions: HS achieving longevity do not face increased risks of preoperative cognitive impairment and postoperative delirium. However, special care is still warranted due to their elevated rate of other complications during hospitalization.

Keywords: Holocaust; anesthesia; delirium; loneliness; perioperative.