Cognitive Impairment as an Effect Modifier of Perioperative Risk in Elderly Patients Undergoing Lumbar Fusion Surgery

This retrospective single-center study followed 243 patients aged 75 or older undergoing lumbar fusion, comparing 57 with preoperative cognitive impairment (CI, by education-adjusted MMSE) to 186 without. Major postoperative complications were more common in the CI group (42.1% vs 33.9%), and CI amplified the harmful effects of frailty, diabetes, and intraoperative transfusion volume on complication risk (significant interaction terms), while also independently predicting worse functional recovery (lower MCID achievement on ODI and VAS scores).

AI summary · from the full text · reviewed by Pukhraj Gaheer, Medical Student, Queen's University before publishing

Why it mattersThis suggests that preoperative cognitive screening could help identify elderly spine surgery patients in whom frailty, diabetes, and blood management deserve extra perioperative attention, though the retrospective, single-center, exploratory design limits how much should change in practice today.

Presenting this at rounds? Start here

• ?Given only 57 patients in the CI subgroup and a stated limitation of reduced model stability, how confident can we be in the three specific interaction effects (diabetes, frailty, transfusion) versus finding them by chance among many variables tested without correction for multiplicity?
• ?If a patient screens positive for cognitive impairment preoperatively, how would you translate this study's findings into a concrete perioperative plan around glycemic control, frailty prehabilitation, and blood management, and what would you tell the patient about expected functional recovery?