What is the prevalence of impaired cognitive domains in surgical patients? A systematic review and meta‐analysis
Bibliographic record
Abstract
BACKGROUND: Cognitive impairment is prevalent in the surgical population but remains significantly under-recognized. This systematic review and meta-analysis aims to (1) assess the prevalence of specific impaired cognitive domains in surgical patients perioperatively and (2) examine postoperative changes across the domains. METHODS: A comprehensive search was conducted in five electronic databases from inception until March 19, 2024. Studies were included if they met the following criteria: (1) surgical patients ≥18 years of age; (2) sample size of ≥100 surgical patients; (3) assessed cognitive domain(s) preoperatively with a neuropsychological battery or clinical evaluation; and (4) reported the prevalence of impaired cognitive domains or changes perioperatively. The exclusion criteria included neurosurgery; those with overlapping data; cross-sectional, case control, and case series studies; and non-English articles. RESULTS: Of the 12,082 articles screened, 21 studies with 5,725 patients were included (11 non-cardiac surgery, 10 cardiac surgery). Preoperatively, executive function had the highest pooled prevalence of impairment (18%; 95% CI: 13%, 24%), followed by visuospatial function (16%; 95% CI: 6%, 26%) and attention/working memory/processing speed (14%, 95% CI: 9%, 18%). Rates were lower in perceptual-motor control (13%; 95% CI: 9%, 36%), language (13%; 95% CI: 8%, 17%), and learning/memory (12%; 95% CI: 8%, 16%) (Figure 1). Postoperatively, impairment was most pronounced at one week, with 35% (95% CI: 4%, 66%) in attention/working memory/processing speed, 34% (95% CI: 16%, 51%) in executive function, and 28% (95% CI: 16%, 40%) in learning/memory. Impairment reduced at three months postoperatively, with a prevalence of 16% (95% CI: 3%, 35%) in attention/working memory/processing speed, 15% (95% CI: 6%, 24%) in executive function, and 12% (95% CI: -2%, 25%) in learning/memory (Figure 2). CONCLUSIONS: Cognitive domains were impaired preoperatively in 12% to 18% of surgical patients. The most commonly impaired domains were executive function, visuospatial function, and attention/working memory/processing speed. One-week post-surgery, the prevalence of impaired cognitive domains rose to 28% to 35%, then decreased by three months to levels similar to preoperative rates (12% to 16%). Identifying commonly impaired cognitive domains can inform the selection of cognitive screening tools to assess surgical patients at greater risk for adverse outcomes.
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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 | 0.015 | 0.041 |
| Meta-epidemiology (narrow) | 0.003 | 0.002 |
| Meta-epidemiology (broad) | 0.018 | 0.038 |
| Bibliometrics | 0.008 | 0.009 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 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".