Cognitive Impairment as an Effect Modifier of Perioperative Risk in Elderly Patients Undergoing Lumbar Fusion Surgery
Spine · 20 Jul 2026
† Impact is the editorial-priority score. All scores are out of 100. Clinical is a stored clinical-importance score from the earlier method; it has not been recalculated.
Why it matters
Spine surgeons increasingly operate on elderly patients, and this suggests cognitive screening could help identify who needs tighter glycemic, frailty, and blood management optimisation before lumbar fusion.
The evidence
This retrospective cohort study looked at 243 patients aged 75 or older who had lumbar fusion surgery, comparing those with preoperative cognitive impairment (CI, n=57, defined by education-adjusted MMSE) to those without (n=186). Patients with CI had more major complications (42.1% vs 33.9%), longer hospital stays, more readmissions, and worse functional recovery, and interaction analyses suggested that diabetes, frailty, and intraoperative transfusion volume had a stronger effect on complications specifically in the CI group.
Major postoperative complications (CCI >20): Odds ratio 0.89 (95% CI 0.83 to 0.95; units not reported). Interpret in the study's stated comparison; this alone does not establish a treatment's causal effect.
Why this rigour score?
Prospective cohort
Methods at a glance
Recorded assessment- Confounding adjustmentMultivariable regression
- Covariate balance confirmedNot reported
- Outcome assessors blindedMet
- Comparable start of follow-upMet
- Adequate statistical powerMet
- Prospective registrationNot reported
Not reported does not mean not done. Checks have different weights; this is not a count of boxes ticked.
How to read this assessment
The recorded methods are shown alongside the published score. A verified point-by-point calculation is not available for this version of the appraisal.
Checklist from the stored appraisal. “Not met” describes the recorded criterion; it does not always produce a deduction. This overview supports reading the full study.
For journal club
1.This is a single-centre retrospective study with only 57 patients in the cognitive impairment subgroup; how much can we trust the stability of the interaction odds ratios (e.g., diabetes AOR 3.62, CI 1.18-11.07) given such small subgroup event counts?
2.If a patient screens positive for cognitive impairment preoperatively, how should that concretely change your perioperative plan for glycemic control, frailty prehabilitation, and blood management before lumbar fusion?
Original publication title
Cognitive Impairment as an Effect Modifier of Perioperative Risk in Elderly Patients Undergoing Lumbar Fusion Surgery