Latent profiles of day-7 cognitive performance and associated ecological factors in older adults after elective surgery: an observational study

Objective To identify latent profiles of postoperative day-7 cognitive performance among older adults after elective surgery and to explore demographic, behavioral, clinical, and social factors associated with profile membership. Methods This prospective observational study included 308 consecutively recruited patients aged ≥65 years who underwent elective surgery under general anesthesia. Cognition was assessed with the Mini-Mental State Examination (MMSE), and latent profile analysis used five study-defined postoperative domain scores. Candidate correlates were organized with the health ecological model and examined using univariate tests and posterior-probability-weighted exploratory multinomial regression. Results Three severity-ordered profiles were identified: low (n=83, 26.9%), intermediate (n=72, 23.4%), and high postoperative cognitive performance (n=153, 49.7%). Older age and lower education were associated with both lower-performance profiles. Greater activities-of-daily-living dependence, lower income, and living alone were associated with the low-performance profile, whereas poorer sleep was associated with the intermediate-performance profile. Conclusions Day-7 MMSE performance formed a severity gradient across three data-driven profiles. These cross-sectional profiles do not demonstrate postoperative decline, a clinical diagnosis, or an effect attributable specifically to general anesthesia. Longitudinal studies with retained baseline scores, appropriate comparison groups, and broader neuropsychological assessment are required before profile-specific interventions can be recommended.