Does cognition status affect spinal surgery outcomes: a systematic review and meta-analysis.

BACKGROUND CONTEXT: Mild cognitive impairment (MCI) and Dementia have been shown to be independent risk factors for complications after spine surgery. To date, no systematic review has been conducted on the effect of cognitive impairment (CI) on spine surgery outcomes.

PURPOSE: This study aims to perform a systematic review and meta-analysis of previous studies on perioperative outcomes and facility-based measures in cognitively impaired patients undergoing spine surgery.

DESIGN

Systematic review and meta-analysis.

PATIENT SAMPLE: A total of 11 articles encompassing approximately 16,070 patients with cognitive impairment were included in this study.

OUTCOMES MEASURED: Data on postoperative outcomes including delirium, urinary tract infection (UTI), myocardial infarction, pulmonary embolism (PE), deep vein thrombosis (DVT), pneumonia, surgical site infection (SSI), wound dehiscence, sepsis, acute kidney injury, reoperation, readmission, intensive care unit (ICU) admission, length of stay, and cost were collected and assessed.

METHODS

A systematic search of PubMed, Embase, Cochrane Library, and Web of Science was conducted on July 8th, 2024. This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies directly comparing spine surgery outcomes in cognitively impaired populations versus normal cognition were included for meta-analysis. A Random-effect model was used to estimate the pooled odds ratios of relevant outcomes. Lumbar and cervical subgroup analyses were also conducted.

RESULTS

A total of 1,074 articles were screened as titles and abstracts. Of these, 54 studies were included for full-text review, yielding 11 articles to be included in this study. These 11 studies (6 retrospective cohort studies, 5 prospective observational studies) directly analyzed the effect of CI on spine surgery outcomes. Random-effect model demonstrated patients with CI were found to have significantly higher odds of developing UTI (OR 4.32[2.24-8.33]), delirium (OR 2.33[1.68-3.22]), DVT (OR 2.49[1.23-5.03]) pneumonia (OR 3.24[1.94-5.43]), wound dehiscence (OR 1.50[1.08-2.08]), and sepsis (OR 2.18[1.04-4.56]). The presence of cognitive impairment was associated with a 2-fold higher odds of ICU admission after surgery (OR 2.05[1.22-3.44]), and 20% increase likelihood of 30-day readmission (OR 1.20[1.03-1.40]) after spine surgery.

CONCLUSION

This study suggests that preoperative CI is associated with worse postoperative health outcomes and inferior facility-based measures in patients undergoing spine surgery. These findings highlight the importance of early recognition and management of cognitive impairment prior to spine surgery, as doing so may mitigate postoperative risks and improve both clinical and facility-based outcomes.