36COGNITIVE IMPAIRMENT AND OUTCOMES IN OLDER UNSELECTED ACUTE SURGICAL ADMISSIONS: A MULTICENTRE STUDY
Bibliographic record
Abstract
The prevalence of cognitive impairment is set to rise. One valid method of measuring cognitive function is through using the Montreal Cognitive Assessment (MoCA). Consequently, we were interested in investigating the outcome of older surgical patients with poor cognition who are admitted to the acute surgical setting. We identified older surgical patients who had lowest 25% of cognition using consecutive acute surgical admission data from Older Persons Surgical Outcomes Collaboration (www.OPSOC.eu) (2013 and 2014). The effect of having a low MoCA score on relevant outcomes of receipt of surgical intervention, 30- and 90-day mortality, readmission within 30-days and hospital length of stay were examined using multivariate logistic regression models, adjusting for age, sex, polypharmacy, haemoglobin, albumin and having diabetes for the first outcome and additionally controlling for surgical intervention for other outcomes. A total of 660 older patients admitted to five surgical units (mean age (SD) = 77(8.1) years) were included. 148 (22.4%) had a MoCA score in the lowest 25% (≤17). The emergency operation rate was 12.0% (N = 79) in this cohort. Characteristic comparisons with the rest of the group showed increasing age, length of hospital stay, polypharmacy and low haemoglobin levels were all significantly associated with having a low MoCA score. A low MoCA score was not associated with sex, low albumin, diabetes or receiving surgical intervention. Multivariate analyses showed low MoCA group had increased 30-day mortality (adjusted odds ratio = 2.84 (95% CI:1.29-6.23; P = 0.009) compared to the remaining cohort. No significant association was found between having a low MoCA score and the other outcomes including receipt of surgical intervention. Whilst low MoCA doesn't appear to preclude the receipt of emergency surgical intervention among older people, our findings highlight the poor prognosis associated with cognitive impairment in older surgical patients.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.005 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".