Spine · IF 2.6 · July 20, 2026 · LoE III
Cognitive Impairment as an Effect Modifier of Perioperative Risk in Elderly Patients Undergoing Lumbar Fusion Surgery
Di Han, Shuai-Kang Wang, Peng Wang, Dongfan Wang, Peng Cui, Xiaolong Chen, Shi-Bao Lu — Capital Medical University
This retrospective cohort study looked at 243 patients aged 75 or older who had lumbar fusion surgery, comparing those with preoperative cognitive impairment (CI, n=57, defined by education-adjusted MMSE) to those without (n=186). Patients with CI had more major complications (42.1% vs 33.9%), longer hospital stays, more readmissions, and worse functional recovery, and interaction analyses suggested that diabetes, frailty, and intraoperative transfusion volume had a stronger effect on complications specifically in the CI group.
AI summary · from the full text · reviewed by Pukhraj Gaheer, Medical Student, Queen's University before publishing
Why it mattersSpine surgeons increasingly operate on elderly patients, and this suggests cognitive screening could help identify who needs tighter glycemic, frailty, and blood management optimization before lumbar fusion.
Conclusion strengthInconclusive
This identifies a risk factor rather than testing a treatment, so it cannot support a change in what we do.
Presenting this at rounds? Start here
- ?This is a single-center retrospective study with only 57 patients in the cognitive impairment subgroup; how much can we trust the stability of the interaction odds ratios (e.g., diabetes AOR 3.62, CI 1.18-11.07) given such small subgroup event counts?
- ?If a patient screens positive for cognitive impairment preoperatively, how should that concretely change your perioperative plan for glycemic control, frailty prehabilitation, and blood management before lumbar fusion?