Patients with undiagnosed neurocognitive deficits may be more likely to have poorer short-term outcomes after hip and knee surgery, suggest orthopedic surgeons from NYU Langone Health.

Their study suggests that patients who scored more poorly on the cognitive impairment tests were significantly more likely to fail to progress in rehabilitation and to require admission into the intensive care unit.

“Our data suggest that neurocognitive impairment is highly prevalent in older individuals who are set to undergo total joint replacements, and we suspect that rates may be underestimated nationwide,” says James Slover, MD, an associate professor of orthopedic surgery at NYU School of Medicine, and an attending orthopedic surgeon and clinical site chief at NYU Langone Orthopedic Hospital, in a media release.

“These patients required more hospital resources and progressed more slowly with physical therapy after surgery. Therefore, it is critical that strategies are developed to screen these patients and protocols are put in place to allocate more support to them before and after surgery.”

The research, presented in a poster session during the recently held American Academy of Orthopaedic Surgeons 2018 Annual Meeting, was published in the Journal of Arthroplasty.

In the study, Slover and his team prospectively screened more than 100 patients who were set to undergo total joint replacements at NYU Langone Orthopedic Hospital for neurocognitive impairment using three validated cognitive tests: a grooved pegboard test for dexterity and coordination for both a dominant and nondominant hand, and an auditory verbal learning test for memory function.

Ninety-nine completed all screening tests before undergoing joint replacements and were followed for at least 1 year. Patients with previously diagnosed neurocognitive conditions, including Alzheimer’s and other dementias, were excluded from the study.

The researchers found that 53% of patients (or 53 out of 99) had neurocognitive deficits identified on at least one of the three tests: There was a significant prevalence of neurocognitive impairment in patients between the ages of 50 and 59 (20 out of 34), though the highest proportion was reported in patients 70 years of age or older (62%, or 13 out of 21 patients screened). Depression was linked to higher likelihood of worse neurocognitive scores, with 77% (13 of 17) patients with depression testing positive for neurocognitive impairment on any test, versus 48% (38 of 79) of non-depressed patients.

Among patients with neurocognitive impairment, statistically significant differences were noted:  48% required ICU admission and medical response team consults, and 64% had failures to progress in physical therapy, compared with 14% and 17% of controls, respectively. These patients also trended toward needing longer length of stays and were more likely to be readmitted to the hospital within 30 days or 1 year of the procedure, but the findings were not statistically significant, the release explains.

Future research will focus on developing pre- and postsurgical evaluations and interventions to improve the outcomes of these patients, and larger studies are planned.

“If we identify patients with neurocognitive impairment prior to a joint replacement, our surgical care team can plan better and concentrate post-operative resources accordingly to make sure we are doing all we can to ensure the best outcomes,” Slover adds in the release.

[Source(s): NYU Langone Health, Newswise]