Does cognition influence the perioperative trajectory of health-related quality of life? A longitudinal prospective cohort study

BACKGROUND: Further characterization is needed to capture the trajectory of health-related quality of life in older surgical populations with cognitive impairment. This study aimed to (1) compare the perioperative trajectory of health-related quality of life between older noncardiac surgical patients with and without cognitive impairment; (2) assess preoperative health-related quality of life values associated with adverse clinical outcomes; and (3) explore preoperative factors associated with poorer health-related quality of life over time. METHODS: Health-related quality of life was assessed online using the EuroQol 5-Dimension 5-Level questionnaire preoperatively and postoperatively at 30, 90, and 180 days. A greater score indicated greater health-related quality of life. Cognition was assessed preoperatively using the Ascertain Dementia Eight-item Questionnaire and the Telephone Montreal Cognitive Assessment. Participants identified as having probable cognitive impairment were referred to as having cognitive impairment. RESULTS: EuroQol 5-Dimension 5-Level questionnaire scores significantly improved within 30 days postoperatively (0.718 ± 0.012 vs 0.690 ± 0.011, P = .04), with sustained gains at 90 (0.784 ± 0.013 vs 0.690 ± 0.011, P ≤ .001) and 180 days (0.797 ± 0.013 vs 0.690 ± 0.011, P ≤ .001). Although participants with cognitive impairment on the Ascertain Dementia Eight-item Questionnaire and those undergoing orthopedic surgery reported poorer health-related quality of life than their counterparts, they exhibited a greater rate of improvement over time. Lower education level, higher pain level, functional disability, depression, and having orthopedic surgery were associated with poorer health-related quality of life across all time points. Poorer preoperative health-related quality of life was associated with a higher incidence of delirium and non-home discharge. CONCLUSION: Health-related quality of life improves by 30 days postoperatively, with a greater rate of improvement among those with cognitive impairment on the Ascertain Dementia Eight-item Questionnaire and those undergoing orthopedic surgery.