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Observational Study
. 2024 Jan;72(1):209-218.
doi: 10.1111/jgs.18627. Epub 2023 Oct 12.

Successful aging after elective surgery II: Study cohort description

Michelle Ward  1 , Tammy T Hshieh  2   3   4 , Eva M Schmitt  2 , Steven E Arnold  4   5 , Michele Cavallari  2   6 , Bradford C Dickerson  4   5 , Simon T Dillon  7 , Tamara G Fong  2   4   8 , Richard N Jones  9 , Towia A Libermann  4   7 , Alvaro Pascual-Leone  2   10   11 , Mouhsin M Shafi  4   8 , Alexandra Touroutoglou  4   5 , Karen Weng  2 , Guoquan Xu  2 , Brandon E Earp  4   12 , Lisa Kunze  4   13 , Jeffrey Lange  4   14 , Kamen Vlassakov  4   15 , Edward R Marcantonio  1   4   16 , Sharon K Inouye  2   4   7 , Thomas G Travison  2   4   7 ; SAGES II Study Team
Collaborators, Affiliations
Observational Study

Successful aging after elective surgery II: Study cohort description

Michelle Ward et al. J Am Geriatr Soc. 2024 Jan.

Abstract

Background: The Successful Aging after Elective Surgery (SAGES) II Study was designed to examine the relationship between delirium and Alzheimer's disease and related dementias (AD/ADRD), by capturing novel fluid biomarkers, neuroimaging markers, and neurophysiological measurements. The goal of this paper is to provide the first complete description of the enrolled cohort, which details the baseline characteristics and data completion. We also describe the study modifications necessitated by the COVID-19 pandemic, and lay the foundation for future work using this cohort.

Methods: SAGES II is a prospective observational cohort study of community-dwelling adults age 65 and older undergoing major non-cardiac surgery. Participants were assessed preoperatively, throughout hospitalization, and at 1, 2, 6, 12, and 18 months following discharge to assess cognitive and physical functioning. Since participants were enrolled throughout the COVID-19 pandemic, procedural modifications were designed to reduce missing data and allow for high data quality.

Results: About 420 participants were enrolled with a mean (standard deviation) age of 73.4 (5.6) years, including 14% minority participants. Eighty-eight percent of participants had either total knee or hip replacements; the most common surgery was total knee replacement with 210 participants (50%). Despite the challenges posed by the COVID-19 pandemic, which required the use of novel procedures such as video assessments, there were minimal missing interviews during hospitalization and up to 1-month follow-up; nearly 90% of enrolled participants completed interviews through 6-month follow-up.

Conclusion: While there are many longitudinal studies of older adults, this study is unique in measuring health outcomes following surgery, along with risk factors for delirium through the application of novel biomarkers-including fluid (plasma and cerebrospinal fluid), imaging, and electrophysiological markers. This paper is the first to describe the characteristics of this unique cohort and the data collected, enabling future work using this novel and important resource.

Keywords: biomarkers; cognitive decline; cognitive impairment; delirium; dementia; long-term cognitive decline.

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Conflict of interest statement

Conflict of Interest: Dr. Pascual-Leone serves as a paid member of the scientific advisory boards for Neuroelectrics, Magstim Inc., TetraNeuron, Skin2Neuron, MedRhythms, and Hearts Radiant. He is co-founder of TI solutions and co-founder and chief medical officer of Linus Health. None of these companies have any interest in or have contributed to the present work. Dr. Pascual-Leone is also listed as an inventor on several issued and pending patents on the real-time integration of transcranial magnetic stimulation with electroencephalography and magnetic resonance imaging, and applications of noninvasive brain stimulation in various neurological disorders. Dr. Lange is an OnPoint Knee scientific advisory board member, Aesculap consultant, and American Association of Hip and Knee Surgeons (AAHKS) committee member. All other co-authors fully disclose they have no financial interests, activities, relationships and affiliations. The co-authors also declare they have no potential conflicts from the three years prior to submission of this manuscript.

Figures

Figure 1.
Figure 1.
Summary of enrollment
Figure 2.
Figure 2.
Sequence and timeline of COVID-19 procedure modifications Abbreviations: DC, discharge; PAT, pre-admission testing; CSF, cerebrospinal fluid; TMS-EEG, transcranial magnetic stimulation/electroencephalography; MRI, magnetic resonance imaging; PET, positron emission tomography.
See this image and copyright information in PMC

References

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