Recommended Citation
Kuster-Kosmoski K, Riutta S, Bukovitz B, Khan A. Preoperative Self-Assessment of Cognition in Older Patients Undergoing Elective Orthopedic Surgery. Presented at Scientific Day; May 20, 2026; Milwaukee, WI.
Abstract
Background/Significance:
Postoperative delirium is a significant problem in older adults undergoing surgery. The risk varies widely by surgery type; for elective orthopedic procedures delirium may occur in >40% of older adults. Many factors influence the risk of delirium; evidence indicates age and pre-existing cognitive impairment are the strongest predictors of postop delirium. Our institution does not have a robust preop screen for cognitive impairment and postop delirium risk in older adults undergoing elective orthopedic procedures.
Purpose:
To preoperatively administer a brief cognitive screening tool, the AD8, to older adults undergoing elective joint replacement surgery to (1) assess feasibility of administering the AD8 during preop education sessions and (2) determine if patients with a higher score on this tool were more likely to develop postop delirium.
Methods:
Patients aged 65 or older undergoing Joint Academy preop education session via phone call between 4/2/25 – 6/5/25 completed the AD8 questionnaire during the session. Questions were read aloud by provider or Spanish interpreter. Patient answers were documented directly into REDCap. Descriptive statistics are used to summarize findings.
Results:
122 questionnaires were administered; 94.3% were completed in 5 minutes or less. Seven patients were excluded from analysis due to data entry error (n=4) or canceled surgery (n=3). Most questionnaires were completed within 30 days of surgery (90.4%). Patients had a median age of 72 yrs (IQR 69-76.5), were majority female (67.8%), and were majority White non-Hispanic (80.9%). Twenty percent of patients (n=23) had an AD8 score ≥2, indicating mild cognitive impairment prior to surgery. Only two patients had documentation of delirium during the post-op period. Of note, the median length of stay was 25.5 hours (IQR 8-29) and only 17.4% of patients had LOS ≥48 hours.
Conclusion:
The AD8 questionnaire was able to be administered quickly, and most patients had their education session within 30 days of surgery, making this an optimal time for preop cognitive screening. This patient group, however, had a very low rate of postop delirium and was typically discharged less than 48 hours after surgery. Given these patients are undergoing elective joint replacement surgery and they are discharged quickly, they have a lower risk of postop delirium and were not an ideal patient population to assess whether preop AD8 screening can predict postoperative delirium.
Presentation Notes
Presented at Scientific Day; May 20, 2026; Milwaukee, WI.
Full Text of Presentation
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Document Type
Oral/Podium Presentation
Preoperative Self-Assessment of Cognition in Older Patients Undergoing Elective Orthopedic Surgery
Background/Significance:
Postoperative delirium is a significant problem in older adults undergoing surgery. The risk varies widely by surgery type; for elective orthopedic procedures delirium may occur in >40% of older adults. Many factors influence the risk of delirium; evidence indicates age and pre-existing cognitive impairment are the strongest predictors of postop delirium. Our institution does not have a robust preop screen for cognitive impairment and postop delirium risk in older adults undergoing elective orthopedic procedures.
Purpose:
To preoperatively administer a brief cognitive screening tool, the AD8, to older adults undergoing elective joint replacement surgery to (1) assess feasibility of administering the AD8 during preop education sessions and (2) determine if patients with a higher score on this tool were more likely to develop postop delirium.
Methods:
Patients aged 65 or older undergoing Joint Academy preop education session via phone call between 4/2/25 – 6/5/25 completed the AD8 questionnaire during the session. Questions were read aloud by provider or Spanish interpreter. Patient answers were documented directly into REDCap. Descriptive statistics are used to summarize findings.
Results:
122 questionnaires were administered; 94.3% were completed in 5 minutes or less. Seven patients were excluded from analysis due to data entry error (n=4) or canceled surgery (n=3). Most questionnaires were completed within 30 days of surgery (90.4%). Patients had a median age of 72 yrs (IQR 69-76.5), were majority female (67.8%), and were majority White non-Hispanic (80.9%). Twenty percent of patients (n=23) had an AD8 score ≥2, indicating mild cognitive impairment prior to surgery. Only two patients had documentation of delirium during the post-op period. Of note, the median length of stay was 25.5 hours (IQR 8-29) and only 17.4% of patients had LOS ≥48 hours.
Conclusion:
The AD8 questionnaire was able to be administered quickly, and most patients had their education session within 30 days of surgery, making this an optimal time for preop cognitive screening. This patient group, however, had a very low rate of postop delirium and was typically discharged less than 48 hours after surgery. Given these patients are undergoing elective joint replacement surgery and they are discharged quickly, they have a lower risk of postop delirium and were not an ideal patient population to assess whether preop AD8 screening can predict postoperative delirium.
Affiliations
Aurora Sinai Family Care Clinic, Aurora UW Medical Group