Association of preoperative cognitive frailty with postoperative complications in elderly patients under general anesthesia: a prospective cohort study

Association of preoperative cognitive frailty with postoperative complications in elderly patients under general anesthesia: a prospective cohort study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Association of preoperative cognitive frailty with postoperative complications in elderly patients under general anesthesia: a prospective cohort study Jiamin FANG, Hao LIANG, Muxin CHEN, Yidi ZHAO, Lin WEI This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4176242/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 19 Oct, 2024 Read the published version in BMC Geriatrics → Version 1 posted 16 You are reading this latest preprint version Abstract Background Cognitive frailty is defined as the coexistence of physical frailty and mild cognitive impairment, which is associated with adverse outcomes. Due to various factors such as age-related changes in the brain and the presence of comorbidities, the elderly are more susceptible to cognitive frailty. Objective To investigate the effect of preoperative cognitive frailty on postoperative complications in elderly patients. Methods This prospective observational study was conducted among 253 patients aged 60–85 years, who underwent elective orthopedic and abdominal surgery (postoperative hospital stay ≥ 3 days ) in the Second Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine from May 2023 to November 2023. Cognitive frailty was assessed using the MoCA for the cognitive status and the Fried criteria for five frailty scales. The participants were split into the following groups: group A, neither frail nor cognitive impairment; group B, only frailty ; group C, only cognitive impairment; group D, cognitive frailty. Primary outcome was the impact on postoperative complications. Secondary outcomes included mobility disability, prolonged hospital stay, re-operation and 90-day readmission. Results The median age ( interquartile range ) of participants was 69 (65–73) years, of which 40.3% were male. The prevalence of cognitive frailty was 17.8%. The incidence of postoperative complications was 18.2% in group A, 50.0% in group B, 37.4% in group C, and 75.6% in group D. The difference was significant ( P < 0.001). In the multivariate analysis, cognitive frailty [odds ratio (OR), 16.84; 95% confidence interval (CI), 4.54–62.37], only frailty (OR, 7.86; 95%CI, 2.12-29. 12), only cognitive impairment (OR, 4.22; 95%CI, 1.62–11.02). Conclusions Cognitive frailty was associated with higher risks of postoperative complications in elderly patients undergoing general anesthesia. It indicates that clinicians should pay much attention to these elderly with cognitive frailty. Cognitive frailty The elderly Operation Complication Figures Figure 1 Figure 2 Figure 3 Introduction With the aging of the world’s population and the advancement in medical surgical techniques, an increasing number of elderly patients are receiving anaesthesia and surgery. Statistics indicate that approximately 313 million surgeries are performed worldwide each year, with one-third of those opting for surgery being elderly patients[ 1 ]. With the continuous development of surgical evaluation methods, many scholars believe that the patient 's own physiological status has a great impact on postoperative prognosis of disease than surgery[ 2 ]. Elderly surgical patients face significant challenges of physiological changes, such as the body dysfunction, mental decline and poor compensatory stress capacity[ 3 ], making them more prone to suffer from postoperative complications, increased medical burden and decreased quality of life than other populations. Consequently, it is crucial to identify modifiable risk factors early and provide supportive interventions to achieve healthy ageing. Frailty is a complex geriatric syndrome that has been shown to be one of the independent risk factors for postoperative adverse outcomes in the elderly[ 4 , 5 ]. Cognitive frailty, as one of the subtypes of frailty, is defined as elderly syndrome with physical frailty and cognitive impairment under the premise of excluding dementia[ 6 ]. Previous researches have shown that cognitive frailty increases the risk of adverse outcomes, such as falls, disability, depression and mortality in the community-dwelling older adults[ 7 – 11 ]. However, the impact of cognitive frailty on postoperative recovery in elderly surgical patients remains unclear. Therefore, we conducted a prospective cohort study to examine the effect of preoperative cognitive frailty on short-term postoperative recovery in elderly patients. The aim is to identify the risk of poor prognosis in elderly surgical patients with cognitive frailty as early as possible, providing a basis for healthcare professionals to develop preoperative optimization strategies and offering a reference for early clinical interventions. Our hypothesis is that elderly patients with cognitive frailty were associated with higher risks of post-operative complications and other adverse outcomes. Materials and Methods Study Design and Participants A cross-sectional design was employed. The participants were recruited from the Second Affiliated Hospital of Guangzhou University of Chinese Medicine from May 2023 to November 2023. Criteria for selecting the participants were as follows: (1) age 60 to 85 years; (2) patients were scheduled for elective orthopedic or abdominal surgery under general anesthesia; (3) The American Society of Anesthesiologists (ASA) classification is I-III; (4) Mini-Cognitive Assessment (Mini-cog) scores>0; (5) postoperative hospital stay ≥ 3 days; (6) vital signs are stable and can cooperate with the completion of the relevant assessment; (7) have good language expression ability, communicate with the investigators without obstacles; Voluntary participation in the study and signed informed consent. Elimination criteria were as follows: (1) participants with a diagnosis of dementia; (2) history of severe neurological or psychiatric disease; (3) serious audiovisual impairments that impacted assessments. Patients were classified into four groups, group A: neither frail nor cognitive impairment group ; group B: cognitive frailty group ; group C: only frailty ; group D: only cognitive impairment group. The trial was registered in the Chinese Clinical Trial Registry in 17/05/2023, ChiCTR2300071535 and approved by the Ethics Committee of Guangdong Provincial Hospital of Chinese Medical (BE2022-165‐01). We followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guidelines. All participants provided written informed consent prior to enrolment. Calculating ample size This study calculates the sample size based on the formula n=[Z²α/2·P(1-P)]/β², where the significance level α is set at 0.05, resulting in Zα/2 = 1.96. The parameter P represents the estimated probability, considering relevant literature indicating a 14.3%[ 12 ] incidence rate of cognitive frailty among elderly hospitalized patients. The margin of error, β, is set at 5%. Accounting for a potential 10% sample loss, the minimum required sample size is determined to be 207 cases. A total of 253 cases were collected in our study, meeting the sample size requirements. Demographic characteristics and clinical data Demographic characteristics and clinical data were collected from each participant before surgery. Age-adjusted charlson comorbidity index ( aCCI ) was used to grade comorbidities[ 13 ], activities of daily living ( using the BI, Barthel index)[ 14 ], nutritional status ( using the NRS2002, nutritional risk screening 2002)[ 15 ], pain ( using the NRS, numerical rating scale)[ 16 ], sleep quality ( using the AIS, Athens Insomnia Scale)[ 17 ], depression ( using the PHQ, Patient Health Questionnaire)[ 18 ], and were uniformly assessed by trained research nurses. Surgery-related data was collected from each participant after surgery, including ASA score, surgery category, surgery time, use analgesia pump, preemptive analgesis,and intraoperative blood loss. Criteria of cognitive frailty According to the criteria, which was proposed jointly by the International Academy on Nutrition and Aging ( I.A.N.A ) and the International Association Gerontology and Geriatrics ( I.A.G.G ) in 2013, cognitive frailty (CF) was defined as simultaneous existence of both physical frailty and cognitive impairment without dementia[ 6 ]. Below are the assessment methods for frailty and cognitive function: Frailty measures Physical frailty was assessed based on the FRAIL scale, which consists of five items (fatigue, resistance, walking, illness, and loss of weight)[ 19 , 20 ]. The Frail scale scores range from 0 to 5, presence of ≥ 3 denotes frailty, 1–2 pre-frailty, and 0 robust. Fatigue and weight loss are biological factors, while resistance and walking ability represent functional aspects, with disease representing the accumulation of deficits. The Frail Scale was measured at baseline. Cognitive function measures Cognitive function was assessed using the Chinese version of the Montreal Cognitive Assessment (MoCA-Chinese Beijing version) scale[ 21 ]. Patients with MoCA ≥ 26 were screened as cognitively normal, and patients with MoCA ≤ 25 were screened as with cognitive impairment. To counterbalance the effect of lower education, 1 point was added to the final score of those individuals with <12 years of education. Furthermore, we performed several methods to promote the assessment quality and methodological reliability, which includes the following: (1) The researchers who conducted MOCA assessment have passed the assessment on the official website and have been certified for the assessment; (2) All the tests were conducted under the direction of the staff who were trained by the neuropsychologists before the study; (3) Collected by the same researcher to avoid measurement bias. The MoCA scale was measured at baseline. Outcome measures The primary outcome of the study was postoperative complications within (5 ± 2) days after surgery. These complications were assessed using the Clavien–Dindo classification system (CD)[ 22 ]. Any events with a grade ≥ 2 were categorized as complications, with Grade II mainly including postoperative infections, hypoalbuminemia, and electrolyte disturbances. Severe complications are grades 3–5 (CD3 complications), mainly including cardiovascular-related complications (heart failure, arrhythmia, myocardial infarction, cardiac arrest, angina pectoris), respiratory-related complications (respiratory failure), neurological complications (stroke, cerebral hemorrhage, delirium), thrombotic complications (deep vein thrombosis, pulmonary embolism) and ICU admission. The secondary outcomes included: (1) Mobility disability. Mobility disability was assessed using the Barthel Index (BI) within (5 ± 2) days after surgery, with a BI score ≤ 60 indicating "yes"[ 23 ]; (2) Prolonged hospital stay. The mean length of hospital stay for patients in this study was (12.30 ± 7.54) days. Following precedent from prior studies, prolonged hospital stay was defined as a length of stay exceeding 75% of the patients' actual hospital stay duration (from admission to discharge)[ 24 ]. Therefore, in this study, prolonged hospital stay was defined as > 16 days; (3) Reoperation; (4) 90-day readmission. Statistical analysis Data were statistically analyzed using SPSS version 25.0 professional statistical software and all the count data are expressed as numbers and percentage (%), and chi-square or Fisher’s exact tests were used for comparisons between groups. Measurement data was expressed as mean (x̄ ± s) standard deviation and those subject to normal distribution between two groups were compared with independent sample t-test. Comparison among the group was analyzed by one-way analysis of variance (ANOVA). Non-normally distributed measures were expressed as median [M ( P25, P75)] and compared between the two groups using the Mann-Whitney U-test. The association between preoperative cognitive frailty and postoperative adverse outcomes was analyzed using univariate and multivariate logistic regression. Then, variables with P < 0.1 in the univariate logistic regression analysis, along with clinically significant variables, were included in the multivariable logistic regression analysis. The difference was considered statistically significant at P < 0.05. Results Baseline characteristics A total of 324 patients were assessed for eligibility, among which 253 patients were finally analyzed, with 77(30.4%) in group A (neither frail nor cognitive impairment group), 45(17.8%) in group B (cognitive frailty group), 24(9.5%) in group C (only frailty) and 107(42.3%) in group D (only cognitive impairment group). The enrollment flow diagram is shown in Fig. 1 . Demographic characteristics and clinical characteristics were shown in Table 1 . There were differences in gender, age, marital status, education, pre-retirement occupation, history of stress (within 1 year), aCCI, preoperative assessment of activities of daily living, nutritional status, sleep quality and depression among the four groups ( P 0.05). Only ASA score was different among the four groups ( P < 0.05 ). Table 1 Characteristics of study participants(n = 253) Variable Overall (n = 253) Neither cognitive decline nor frailty (n = 77) Only frailty (n = 24) Only cognitive decline (n = 107) Cognitive frailty (n = 45) P value Sex 0.048 Male 102 (40.3) 37 (48.1) 7 (29.2) 35 (32.7) 23 (51.1) Female 151 (59.7) 40 (51.9) 17 (70.8) 72 (67.3) 22 (48.9) Age, years 69.0 (65.0, 73.0) 68.0 (65.0, 73.0) 68.0 (65.0, 72.2) 69.0 (65.0, 72.0) 73.0 (70.0, 78.0) < 0.001 Marital status 0.004 Marriage 228 (90.1) 73 (94.8) 16 (66.7) 97 (90.7) 42 (93.3) Divorced or widowed 25 ( 9.9) 4 (5.2) 8 (33.3) 10 (9.3) 3 (6.7) BMI, kg/m 2 23.9 ± 3.5 23.9 ± 3.6 23.9 ± 3.8 24.2 ± 3.3 23.2 ± 3.5 0.432 Education < 0.001 Below Primary 86 (34.0) 7 (9.1) 2 (8.3) 51 (47.7) 26 (57.8) Meddle 76 (30.0) 21 (27.3) 8 (33.3) 36 (33.6) 11 (24.4) High 69 (27.3) 37 (48.1) 9 (37.5) 17 (15.9) 6 (13.3) University 22 ( 8.7) 12 (15.6) 5 (20.8) 3 (2.8) 2 (4.4) Pre-retirement occupation 0.019 Physical strength 109 (43.1) 24 (31.2) 7 (29.2) 60 (56.1) 18 (40) Both mental and physical strength 91 (36.0) 34 (44.2) 10 (41.7) 32 (29.9) 15 (33.3) Mental strength 53 (20.9) 19 (24.7) 7 (29.2) 15 (14) 12 (26.7) Smoking status 0.671 No 216 (85.4) 65 (84.4) 19 (79.2) 94 (87.9) 38 (84.4) Yes 37 (14.6) 12 (15.6) 5 (20.8) 13 (12.1) 7 (15.6) Alcohol status 0.687 No 229 (90.5) 72 (93.5) 21 (87.5) 96 (89.7) 40 (88.9) Yes 24 ( 9.5) 5 (6.5) 3 (12.5) 11 (10.3) 5 (11.1) Multiple medication 0.764 No 233 (92.1) 71 (92.2) 22 (91.7) 100 (93.5) 40 (88.9) Yes 20 ( 7.9) 6 (7.8) 2 (8.3) 7 (6.5) 5 (11.1) History of stress(within 1 year) 0.015 No 155 (61.3) 55 (71.4) 14 (58.3) 67 (62.6) 19 (42.2) Yes 98 (38.7) 22 (28.6) 10 (41.7) 40 (37.4) 26 (57.8) aCCI 4.0 (3.0, 5.0) 4.0 (2.0, 5.0) 4.0 (3.0, 5.0) 3.0 (2.0, 5.0) 5.0 (4.0, 6.0) < 0.001 Activities of daily living 95.0 (90.0, 100.0) 100.0 (95.0, 100.0) 95.0 (83.8, 96.2) 95.0 (95.0, 100.0) 90.0 (70.0, 95.0) < 0.001 Nutritional status 0.0 (0.0, 1.0) 0.0 (0.0, 1.0) 0.0 (0.0, 2.0) 0.0 (0.0, 0.0) 1.0 (0.0, 3.0) < 0.001 Pain 0.0 (0.0, 2.0) 0.0 (0.0, 1.0) 1.0 (0.0, 2.2) 0.0 (0.0, 3.0) 1.0 (0.0, 2.0) 0.387 Sleep quality 3.0 (1.0, 7.0) 3.0 (1.0, 6.0) 2.0 (1.8, 4.2) 3.0 (1.0, 7.0) 6.0 (3.0, 8.0) 0.006 Depression 2.0 (1.0, 4.0) 2.0 (0.0, 3.0) 3.0 (1.0, 4.0) 2.0 (1.0, 4.0) 5.0 (2.0, 9.0) < 0.001 ASA score < 0.001 Level 2 178 (70.4) 63 (81.8) 16 (66.7) 80 (74.8) 19 (42.2) Level 3 75 (29.6) 14 (18.2) 8 (33.3) 27 (25.2) 26 (57.8) Surgery category 0.16 Abdomen 121 (47.8) 41 (53.2) 11 (45.8) 44 (41.1) 25 (55.6) Limbs 82 (32.4) 25 (32.5) 6 (25) 42 (39.3) 9 (20) Spine 50 (19.8) 11 (14.3) 7 (29.2) 21 (19.6) 11 (24.4) Surgery time, min 140.0 (102.0, 196.0) 145.0 (100.0, 188.0) 130.5 (103.8, 178.5) 131.0 (101.0, 184.0) 170.0 (115.0, 218.0) 0.262 Use analgesia pump 0.769 No 20 ( 7.9) 6 (7.8) 2 (8.3) 7 (6.5) 5 (11.1) Yes 233 (92.1) 71 (92.2) 22 (91.7) 100 (93.5) 40 (88.9) Preemptive analgesis 0.377 No 134 (53.0) 43 (55.8) 12 (50) 51 (47.7) 28 (62.2) Yes 119 (47.0) 34 (44.2) 12 (50) 56 (52.3) 17 (37.8) Intraoperative blood loss, mL 50.0 (20.0, 100.0) 50.0 (20.0, 50.0) 45.2 (27.5, 100.0) 50.0 (30.0, 100.0) 50.0 (30.0, 100.0) 0.239 *BMI, body mass index; aCCI, age-adjusted Charlson Co-morbidity index; Activities of daily living was assessed using the BI (Barthel index); Nutritional status was assessed using the NRS2002 (nutritional risk screening 2002); Pain was assessed using the NRS (numerical rating scale); Sleep quality was assessed using the AIS (Athens Insomnia Scale); Depression was assessed using the PHQ (Patient Health Questionnaire); ASA: American Society of Anesthesiologists Classification of post-operative complications One hundred patients experienced a complication classified as Clavien-Dindo grade ≥ II, with 18 elderly patients experienced CD3 complications(grades ≥ III). Figure 2 and Fig. 3 illustrate the frequencies of Grade II and CD3 complications respectively, among four groups of cognitive frailty during the study. Associations of cognitive frailty with post-operative outcomes The differences in postoperative complications, postoperative mobility disability, prolonged hospitalization time and reoperation among the four groups ( P < 0.001). No significant differences in the 90-day readmission among the four groups ( P = 0.092) (Table 2 ). Table 2 Short-term postoperative outcomes Variable Overall (n = 253) Neither cognitive decline nor frailty (n = 77) Only frailty (n = 24) Only cognitive decline (n = 107) Cognitive frailty(n = 45) P value postoperative complication (CD ≥ II) < 0.001 No 153 (60.5) 63 (81.8) 12 (50) 67 (62.6) 11 (24.4) Yes 100 (39.5) 14 (18.2) 12 (50) 40 (37.4) 34 (75.6) CD3 complication < 0.001 No 235 (92.9) 76 (98.7) 22 (91.7) 103 (96.3) 34 (75.6) Yes 18 ( 7.1) 1 (1.3) 2 (8.3) 4 (3.7) 11 (24.4) Post infection < 0.001 No 232 (91.7) 77 (100) 22 (91.7) 101 (94.4) 32 (71.1) Yes 21 ( 8.3) 0 (0) 2 (8.3) 6 (5.6) 13 (28.9) Hypoalbuminemia < 0.001 No 217 (85.8) 71 (92.2) 20 (83.3) 98 (91.6) 28 (62.2) Yes 36 (14.2) 6 (7.8) 4 (16.7) 9 (8.4) 17 (37.8) Electrolyte disturbances < 0.001 No 186 (73.5) 69 (89.6) 17 (70.8) 78 (72.9) 22 (48.9) Yes 67 (26.5) 8 (10.4) 7 (29.2) 29 (27.1) 23 (51.1) Mobility disability < 0.001 No 209 (82.6) 69 (89.6) 18 (75) 95 (88.8) 27 (60) Yes 44 (17.4) 8 (10.4) 6 (25) 12 (11.2) 18 (40) Prolonged hospital stay 0.008 No 217 (85.8) 70 (90.9) 21 (87.5) 95 (88.8) 31 (68.9) Yes 36 (14.2) 7 (9.1) 3 (12.5) 12 (11.2) 14 (31.1) Reoperation 0.285 No 240 (94.9) 74 (96.1) 23 (95.8) 103 (96.3) 40 (88.9) Yes 13 ( 5.1) 3 (3.9) 1 (4.2) 4 (3.7) 5 (11.1) 90-day readmission 0.092 No 205 (81.0) 59 (76.6) 19 (79.2) 94 (87.9) 33 (73.3) Yes 48 (19.0) 18 (23.4) 5 (20.8) 13 (12.1) 12 (26.7) *Mobility disability was assessed using the ADL (activities of daily living). Associations of cognitive frailty with post-operative outcomes In the univariate logistic regression analysis of adverse postoperative outcomes, differences were observed among gender, age, BMI, education, smoking status, history of stress(within 1 year), aCCI, NRS, NRS2002, ADL, ASA score, surgery category and surgery time( P < 0.1). ( Table 3 ) Multivariate logistic regression analysis revealed that cognitive frailty increased the incidence of postoperative complications, CD3 complications, mobility disability and prolonged hospitalization in the elderly in the adjusted model 1 (adjusted age, marital status, BMI, education, pre-retirement occupation, smoking and drinking) and the adjusted model 2 (adding multiple medication, history of stress(within 1 year), aCCI, NRS, NRS2002, ADL and PHQ on the basis of adjusted model 1). Cognitive frailty increased the incidence of postoperative complications, CD3 complications and prolonged hospital stay in the elderly in the adjusted model 3 (on the basis of the adjusted model 2, increase ASA score, surgery category, and surgery time). Compared with the elderly with only preoperative frailty or cognitive impairment, the elderly with preoperative cognitive frailty have a higher risk of postoperative adverse outcomes. ( Table 4 ) Table 3 Univariate logistic regression of postoperative outcomes Variable Postoperative complication CD3 complication Mobility disability Prolonged hospital stay OR (95%CI) P value OR (95%CI) P value OR (95%CI) P value OR (95%CI) P value Sex (Female) 0.63 (0.38 ~ 1.06) 0.081 0.63 (0.38 ~ 1.06) 0.081 0.62 (0.32 ~ 1.21) 0.164 0.94 (0.46 ~ 1.92) 0.858 Age 1.09 (1.04 ~ 1.14) < 0.001 1.09 (1.04 ~ 1.14) < 0.001 1.06 (1.01 ~ 1.12) 0.029 1.02 (0.96 ~ 1.08) 0.477 Marriage (Divorced or widowed) 1.47 (0.64 ~ 3.36) 0.363 1.47 (0.64 ~ 3.36) 0.363 1.29 (0.46 ~ 3.66) 0.631 0.5 (0.11 ~ 2.2) 0.357 BMI 0.94 (0.87 ~ 1.01) 0.083 0.94 (0.87 ~ 1.01) 0.083 0.97 (0.88 ~ 1.07) 0.546 0.95 (0.85 ~ 1.05) 0.296 Education (Meddle) 0.72 (0.39 ~ 1.35) 0.305 0.72 (0.39 ~ 1.35) 0.305 0.85 (0.39 ~ 1.86) 0.689 0.52 (0.2 ~ 1.37) 0.187 Education (High) 0.37 (0.19 ~ 0.73) 0.004 0.37 (0.19 ~ 0.73) 0.004 0.57 (0.24 ~ 1.36) 0.202 0.67 (0.27 ~ 1.71) 0.408 Education (University) 0.73 (0.28 ~ 1.87) 0.507 0.73 (0.28 ~ 1.87) 0.507 0.18 (0.02 ~ 1.43) 0.105 2.4 (0.83 ~ 6.96) 0.107 Pre-retirement occupation (Both mental and physical strength ) 1.35 (0.76 ~ 2.38) 0.307 1.35 (0.76 ~ 2.38) 0.307 0.86 (0.41 ~ 1.83) 0.698 1.23 (0.55 ~ 2.74) 0.607 Pre-retirement occupation (Mental strength) 1.27 (0.65 ~ 2.49) 0.48 1.27 (0.65 ~ 2.49) 0.48 0.97 (0.41 ~ 2.32) 0.943 1.21 (0.47 ~ 3.08) 0.695 Smoking 0.92 (0.45 ~ 1.89) 0.82 0.92 (0.45 ~ 1.89) 0.82 0.97 (0.38 ~ 2.49) 0.946 1.85 (0.77 ~ 4.46) 0.169 Drinking 2.82 (1.18 ~ 6.73) 0.019 2.82 (1.18 ~ 6.73) 0.019 0.7 (0.2 ~ 2.45) 0.572 2.21 (0.81 ~ 6.01) 0.12 Multiple medication 1.28 (0.51 ~ 3.2) 0.603 1.28 (0.51 ~ 3.2) 0.603 0.88 (0.25 ~ 3.14) 0.841 0.3 (0.04 ~ 2.3) 0.245 History of stress(within 1 year) 2.35 (1.39 ~ 3.95) 0.001 2.35 (1.39 ~ 3.95) 0.001 1.23 (0.63 ~ 2.4) 0.549 1.71 (0.84 ~ 3.48) 0.137 ASA score 1.64 (0.95 ~ 2.84) 0.075 1.64 (0.95 ~ 2.84) 0.075 1.79 (0.9 ~ 3.56) 0.095 2.81 (1.37 ~ 5.77) 0.005 Surgery category 0.25 (0.13 ~ 0.47) < 0.001 0.36 (0.18 ~ 0.72) 0.004 0.99 (0.51 ~ 1.92) 0.979 0.68 (0.34 ~ 1.39) 0.294 Surgery time 0.36 (0.18 ~ 0.72) 0.004 1 (1 ~ 1) 0.948 1.01 (1 ~ 1.01) 0.002 1.01 (1.01 ~ 1.02) < 0.001 aCCI 1 (1 ~ 1) 0.948 1.39 (1.19 ~ 1.63) < 0.001 1.11 (0.92 ~ 1.33) 0.285 1.09 (0.89 ~ 1.32) 0.407 Nutritional status 1.39 (1.19 ~ 1.63) < 0.001 1.52 (1.2 ~ 1.94) 0.001 1.28 (0.96 ~ 1.7) 0.094 1.5 (1.12 ~ 2.02) 0.006 Pain 1.52 (1.2 ~ 1.94) 0.001 0.89 (0.73 ~ 1.08) 0.219 1.16 (0.92 ~ 1.47) 0.214 1.04 (0.8 ~ 1.35) 0.787 Sleep quality 0.89 (0.73 ~ 1.08) 0.219 1.02 (0.96 ~ 1.09) 0.487 1.03 (0.95 ~ 1.11) 0.48 1.02 (0.94 ~ 1.11) 0.675 Activities of daily living 1.02 (0.96 ~ 1.09) 0.487 0.97 (0.95 ~ 0.99) 0.001 0.96 (0.94 ~ 0.98) < 0.001 1 (0.98 ~ 1.03) 0.719 Depression 0.97 (0.95 ~ 0.99) 0.001 1.14 (1.05 ~ 1.24) 0.001 1.04 (0.95 ~ 1.15) 0.41 1.05 (0.95 ~ 1.16) 0.339 Table 4 Multivariate logistic regression of postoperative outcomes Model Exposure Postoperative Outcomes Postoperative complication CD3 complication Mobility disability Prolonged hospital stay Neither cognitive decline nor frailty 1(Ref) 1(Ref) 1(Ref) 1(Ref) Unadjusted (OR,95%, CI) Cognitive frailty 13.91 (5.69 ~ 33.98) 24.59 (3.05 ~ 198.14) 7.31 (2.75 ~ 19.4) 4.52 (1.66 ~ 12.29) Only frailty 4.5 (1.68 ~ 12.08) 6.91 (0.6 ~ 79.82) 2.63 (0.75 ~ 9.23) 1.43 (0.34 ~ 6.02) Only cognitive decline 2.69 (1.34 ~ 5.41) 2.95 (0.32 ~ 26.94) 1.15 (0.42 ~ 3.1) 1.26 (0.47 ~ 3.37) Adjusted I (OR,95%, CI) Cognitive frailty 10.6 (3.8 ~ 29.59) 30.72 (2.65 ~ 356.42) 6.01 (1.91 ~ 18.89) 6.74 (1.95 ~ 23.24) Only frailty 5.29 (1.75 ~ 15.95) 6.21 (0.45 ~ 85.39) 3.18 (0.8 ~ 12.62) 1.15 (0.24 ~ 5.56) Only cognitive decline 2.72 (1.19 ~ 6.22) 4.47 (0.38 ~ 52.87) 0.99 (0.33 ~ 2.96) 1.72 (0.55 ~ 5.41) Adjusted II (OR,95%, CI) Cognitive frailty 6.9 (2.25 ~ 21.17) 32.53 (2.17 ~ 486.79) 5.41 (1.33 ~ 21.98) 10.67 (2.49 ~ 45.7) Only frailty 4.86 (1.52 ~ 15.5) 8.64 (0.52 ~ 143.81) 2.96 (0.69 ~ 12.68) 1.16 (0.22 ~ 6.13) Only cognitive decline 2.83 (1.17 ~ 6.81) 5.96 (0.4 ~ 88.15) 0.88 (0.27 ~ 2.84) 2.11 (0.63 ~ 7.07) Adjusted III (OR,95%, CI) Cognitive frailty 16.84 (4.54 ~ 62.37) 49.01 (2.42 ~ 990.78) 4.95 (1.01 ~ 24.23) 10.95 (1.95 ~ 61.45) Only frailty 7.86 (2.12 ~ 29.12) 17.18 (0.77 ~ 382.89) 4.67 (0.9 ~ 24.28) 1.3 (0.21 ~ 8.05) Only cognitive decline 4.22 (1.62 ~ 11.02) 8.26 (0.45 ~ 152.7) 0.9 (0.24 ~ 3.42) 2.9 (0.72 ~ 11.74) *Model 1: adjusted for gender, age, marital status, BMI, education, Pre-retirement occupation, Smoking status, alcohol status Model 2: adjusted Model 1 plus multiple medication, history of stress(within 1 year), aCCI, NRS, NRS2002, ADL, PHQ Model 3:adjusted Model 2 plus ASA score, surgery category, and surgery time Discussion This is the first study to explore the association between preoperative cognitive frailty and adverse outcomes in elderly patients undergoing surgery under general anesthesia. Our prospective study has found that cognitive frailty is an independent risk factor for adverse postoperative outcomes in elderly patients undergoing general anesthesia. Besides, elderly patients with preoperative cognitive frailty have poor postoperative recovery, which includes a high incidence of postoperative complications, mobility disability and prolonged hospital stay. In our study, the prevalence of preoperative cognitive frailty in elderly patients undergoing elective orthopedic or abdominal general anesthesia surgery was 17.79%, which was higher than the results of Ma[ 25 ], Brigola[ 26 ], and Yu[ 27 ] in the community elderly (2.9%, 10.9%, 8.7%). This may be due to the lack of uniform diagnostic criteria and assessment methods for cognitive frailty, as well as significant differences in the different study designs. In addition, some scholars have found that the prevalence of cognitive frailty in clinical settings can be as high as 37.40%-50.9%[ 28 , 29 ]. It may be attributed to the impact of the disease on elderly patients undergoing elective general anesthesia surgery, resulting in a decrease in physiological reserve, low immunity and stress response ability, which increases the incidence of cognitive frailty. We found that cognitive frailty was an independent risk factor for postoperative complications in elderly patients undergoing general anesthesia. Multivariate logistic regression analysis showed that the elderly in the preoperative cognitive frailty group were more likely to have postoperative complications and CD3 complications than those in the only frailty group or the only cognitive impairment group. A review has shown that physical frailty and cognitive dysfunction have similar pathophysiological mechanisms, such as mitochondrial dysfunction and oxidative stress, inflammatory response, and endocrine disorders[ 30 ]. Frailty is a geriatric syndrome resulting from age-related cumulative decline across multiple physiologic systems, impaired homeostatic reserve, and reduced capacity to resist stress[ 31 ]. Prior work has shown that frail is an important factor in risk stratification and outcome prediction[ 32 , 33 ], and it was associated with an increased risk for postoperative complications, length of stay health care burdens, and other survival outcomes[ 34 – 36 ]. Cognitive dysfunction refers to different degrees of cognitive impairment stemming from various causes, and it is also known to be associated with increased risk of adverse events post operative, complications of coexisting medical conditions, decreased mobility, increased healthcare utilization, and substantial caregiver burden[ 37 , 38 ]. Cognitive frailty is the superposition of the above two. The coexistence of the two can accelerate the decline of physical and cognitive functions and form a vicious cycle, bringing more serious cumulative effects on the body[ 39 , 40 ]. This is consistent with the results of the analysis in this study, showing that the elderly with cognitive frailty had the highest risk of adverse postoperative outcomes compared with the purely frailty or purely cognitive impairment group. Different from previous research[ 38 , 41 , 42 ], multivariate logistic regression analysis in our study revealed no significant association between frailty and cognitive impairment with postoperative mobility disability or prolonged hospital stay. This could be attributed to the categorization of different states of frailty and cognitive impairment into four distinct groups, where patients with cognitive frailty were no longer classified into the frailty or cognitive impairment groups, resulting in a relatively lower incidence rate of frail. Additionally, it may also be influenced by the use of different assessment scales for frailty and cognitive impairment. A substantial amount of research has found that association between cognitive frailty in community-dwelling older adults and various adverse outcomes[ 43 – 45 ]. Many communities have incorporated cognitive frailty into their assessments. However, due to the unclear impact of preoperative cognitive frailty on postoperative recovery in the elderly, many countries have not yet included it in clinical practice assessments. Our study indicates that preoperative cognitive frailty is associated with adverse postoperative outcomes in elderly patients. It suggests that healthcare professionals need to pay more attention to cognitive frailty in elderly patients. Besides, it also provides clinical evidence for early screening and intervention for cognitive frailty. One strength of this study is that the research object was elderly patients undergoing general anesthesia surgery. This is the first study to investigate the relationship between preoperative cognitive frailty and adverse outcomes in elderly patients undergoing elective orthopedic or abdominal general anesthesia surgery. Previous studies on cognitive frailty have mainly focused on the community, and there are few studies on the elderly hospitalized, especially the elderly undergoing surgery. The elderly are more vulnerable to stressors due to their reduced physiological reserves and decreased ability to maintain balance in the body, and surgery as a major physical and psychological blow will deplete the elderly 's limited reserves and lead to decompensation[ 46 ]. In addition, the type of the surgery included in this study focused on the high-risk surgery group rather than extensively assessing the risk of different procedures. Due to orthopedic and abdominal general anesthesia surgery as the most common surgical procedures in the elderly. So, this study selected the higher-risk surgical methods in these two types of surgery to explore the impact of cognitive frailty on elderly patients undergoing general anesthesia surgery. There are some limitations to our study. First, this is a single-center study, which limits the generalizability of its conclusions. Second, unmeasured confounders may exist because of the observational nature of this research. Third, some of the self-reported parameters are subjective in nature and may introduce informational bias. Fourth, although the cognitive frailty group had a higher risk of CD3 complications (15.6% vs. 0%) than the fit group, the small number of patients in each group and low incidence rate of adverse outcomes may limit the statistical power in detecting the significance of the in-group differences in this study. Finally, the long term effects of cognitive frailty on postoperative recovery in elderly patients were not observed. Hence, further multi-centre, large sample trials are needed to investigate the long-term impacts of cognitive frailty on postoperative recovery in elderly patients and explore the effective treatment for cognitive frailty. Conclusions Although screening cognitive frailty is not routine clinical practice for hospitalized patients, resulting in neglect of the potential risk of cognitive frailty by medical staff, our study indicates the cumulative effects of combined frailty and cognitive impairment on adverse outcomes and demonstrating the importance of cognitive frailty to identify patients at high risk for adverse surgical outcomes, and highlighting the need for future studies to develop interventions, such as preoperative prehabilitation to mitigate this risk. It is very important that clinicians pay more attention to these elderly with cognitive frailty. Abbrevlations MoCA: Montreal Cognitive Assessment; OR: odds ratio; CI:confidence interval; BMI: body mass index; aCCI: age-adjusted Charlson Co-morbidity index; BI: Barthel index; NRS2002: nutritional risk screening 2002; NRS:numerical rating scale; AIS: Athens Insomnia Scale; PHQ: Patient Health Questionnaire; ASA: American Society of Anesthesiologist. Declarations Acknowledgments Not applicable. Author’s contributions All authors contributed intellectually to the study. They substantially contributed to the conception or design of the work and drafted the manuscript. Wei and Fang oversaw quality control and provided protocol guidance for the study. All authors were involved in information collection, data entry, and manuscript writing. Data analysis was conducted by Fang. All authors have read and approved the final manuscript. Funding This study was supported by The Institute of Science and Technology of the National Health Commission of the People’s Republic of China (No.2021KYSHX016010201). Commercial funding was not received. Availability of data and materials The data collected in this study is not publicly available because the participants did not consent to the public release of their data. However, the corresponding author may provide further analytical information and supporting data upon reasonable request. Ethics approval and conset to participate Ethics approved has been received from the Ethics Committee of Guangdong Provincial Hospital of Chinese Medical (Ethics Document Batch number: BE2022‐165‐01). The study was carried out in compliance with the Helsinki Declaration, and all the participants provided written informed consent prior to enrolment. We followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guidelines. Consent for publication Not applicable. Competing interests The authors declare that they have no conflict of interest. Author details 1 State Key Laboratory of Traditional Chinese Medicine Syndrome, the Second Clinical Medical School of Guangzhou University of Chinese Medicine, Guangzhou 510006, P. R China 2 Department of Neurology, the Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510120, P. R China 3 College of Nursing, Hunan University of Traditional Chinese Medicine, Changsha 410208, P. R China 4 State Key Laboratory of Traditional Chinese Medicine Syndrome, the Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120, P. R China References Weiser TG, Haynes AB, Molina G, Lipsitz SR, Esquivel MM, Uribe-Leitz T, Fu R, Azad T, Chao TE, Berry WR, et al. Estimate of the global volume of surgery in 2012: an assessment supporting improved health outcomes. Lancet (London England). 2015;385(Suppl 2):S11. Story DA. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4176242","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":288625696,"identity":"4955be97-304c-4bdf-b0e3-0e286bf2bcd5","order_by":0,"name":"Jiamin FANG","email":"","orcid":"","institution":"State Key Laboratory of Traditional Chinese Medicine Syndrome, the Second Clinical Medical School of Guangzhou University of Chinese Medicine","correspondingAuthor":false,"prefix":"","firstName":"Jiamin","middleName":"","lastName":"FANG","suffix":""},{"id":288625700,"identity":"613fe3d9-d32b-43f0-a2c7-0523d588d665","order_by":1,"name":"Hao LIANG","email":"","orcid":"","institution":"Department of Neurology, the Second Affiliated Hospital of Guangzhou University of Chinese Medicine","correspondingAuthor":false,"prefix":"","firstName":"Hao","middleName":"","lastName":"LIANG","suffix":""},{"id":288625701,"identity":"37094449-c6f8-49b3-bc4c-542e48db4521","order_by":2,"name":"Muxin CHEN","email":"","orcid":"","institution":"State Key Laboratory of Traditional Chinese Medicine Syndrome, the Second Clinical Medical School of Guangzhou University of Chinese Medicine","correspondingAuthor":false,"prefix":"","firstName":"Muxin","middleName":"","lastName":"CHEN","suffix":""},{"id":288625703,"identity":"a56bb549-ddbd-4cff-8cca-e4de38da5d76","order_by":3,"name":"Yidi ZHAO","email":"","orcid":"","institution":"College of Nursing, Hunan University of Traditional Chinese Medicine","correspondingAuthor":false,"prefix":"","firstName":"Yidi","middleName":"","lastName":"ZHAO","suffix":""},{"id":288625707,"identity":"c4f6340a-b829-471f-bcb4-08202ae642af","order_by":4,"name":"Lin WEI","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA60lEQVRIie3OsYrCMBzH8YRApmLXlELvFSKFgiD4KilCJwffwByFbuLqPcGtglAcUwSzFG79b2cWX8Cp013bQbe0o2C+kAzh94Eg5HK9YFzhTyXQPPIfT2qYyJZkcSDHk35zTg+P5SDRuVTmRPDx5/vGmhWKJiDwfW0hSV1JldaUJHDNgm2J4gAECfc2AmlLCo8moC4hLlF6AEGJZyO/piPMi/dV0ZHNIFkA7ghn3M9pRwQfIrO6/5jgDCiZbUs2/apNHtoI19qYpvjb7HbaQFPOPyZ6Wd1t5BkT/d0eLEcBhHw1cuhyuVxv1z+twlfkwUbqJgAAAABJRU5ErkJggg==","orcid":"","institution":"State Key Laboratory of Traditional Chinese Medicine Syndrome, the Second Affiliated Hospital of Guangzhou University of Chinese Medicine","correspondingAuthor":true,"prefix":"","firstName":"Lin","middleName":"","lastName":"WEI","suffix":""}],"badges":[],"createdAt":"2024-03-27 12:58:23","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4176242/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4176242/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12877-024-05431-1","type":"published","date":"2024-10-19T15:57:36+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":54371803,"identity":"9ff6c48d-0e33-4fc3-9eb7-9857d57b85fa","added_by":"auto","created_at":"2024-04-09 13:16:34","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":100976,"visible":true,"origin":"","legend":"\u003cp\u003estudy participant flow diagram\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-4176242/v1/09fb596b391d3f5ecc1c58a4.png"},{"id":54371767,"identity":"52731c3a-90d6-4474-bd52-b960e84d9838","added_by":"auto","created_at":"2024-04-09 13:16:22","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":35101,"visible":true,"origin":"","legend":"\u003cp\u003eGrade II complications classification\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-4176242/v1/899718df541646551c9c574a.png"},{"id":54371774,"identity":"71b3bd79-33a9-43cb-b04a-b8c987a97498","added_by":"auto","created_at":"2024-04-09 13:16:27","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":35192,"visible":true,"origin":"","legend":"\u003cp\u003eCD3 complications classification\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-4176242/v1/9708eb01c28ebf51b2737c5e.png"},{"id":67149274,"identity":"37b2dee9-1732-4e15-97ec-ec82ac3c0896","added_by":"auto","created_at":"2024-10-21 16:12:56","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1510710,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4176242/v1/61a7363b-66c2-4108-a55a-32e3cbbbbe13.pdf"},{"id":54371775,"identity":"cc13bd0c-29ec-4219-8170-82f019691076","added_by":"auto","created_at":"2024-04-09 13:16:27","extension":"xlsx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":112501,"visible":true,"origin":"","legend":"","description":"","filename":"analysis.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-4176242/v1/c7baa00b5c3871375dd9c0e6.xlsx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Association of preoperative cognitive frailty with postoperative complications in elderly patients under general anesthesia: a prospective cohort study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eWith the aging of the world\u0026rsquo;s population and the advancement in medical surgical techniques, an increasing number of elderly patients are receiving anaesthesia and surgery. Statistics indicate that approximately 313\u0026nbsp;million surgeries are performed worldwide each year, with one-third of those opting for surgery being elderly patients[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. With the continuous development of surgical evaluation methods, many scholars believe that the patient 's own physiological status has a great impact on postoperative prognosis of disease than surgery[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Elderly surgical patients face significant challenges of physiological changes, such as the body dysfunction, mental decline and poor compensatory stress capacity[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e], making them more prone to suffer from postoperative complications, increased medical burden and decreased quality of life than other populations. Consequently, it is crucial to identify modifiable risk factors early and provide supportive interventions to achieve healthy ageing.\u003c/p\u003e \u003cp\u003eFrailty is a complex geriatric syndrome that has been shown to be one of the independent risk factors for postoperative adverse outcomes in the elderly[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Cognitive frailty, as one of the subtypes of frailty, is defined as elderly syndrome with physical frailty and cognitive impairment under the premise of excluding dementia[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Previous researches have shown that cognitive frailty increases the risk of adverse outcomes, such as falls, disability, depression and mortality in the community-dwelling older adults[\u003cspan additionalcitationids=\"CR8 CR9 CR10\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. However, the impact of cognitive frailty on postoperative recovery in elderly surgical patients remains unclear. Therefore, we conducted a prospective cohort study to examine the effect of preoperative cognitive frailty on short-term postoperative recovery in elderly patients. The aim is to identify the risk of poor prognosis in elderly surgical patients with cognitive frailty as early as possible, providing a basis for healthcare professionals to develop preoperative optimization strategies and offering a reference for early clinical interventions. Our hypothesis is that elderly patients with cognitive frailty were associated with higher risks of post-operative complications and other adverse outcomes.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\n \u003ch2\u003eStudy Design and Participants\u003c/h2\u003e\n \u003cp\u003eA cross-sectional design was employed. The participants were recruited from the Second Affiliated Hospital of Guangzhou University of Chinese Medicine from May 2023 to November 2023. Criteria for selecting the participants were as follows: (1) age 60 to 85 years; (2) patients were scheduled for elective orthopedic or abdominal surgery under general anesthesia; (3) The American Society of Anesthesiologists (ASA) classification is I-III; (4) Mini-Cognitive Assessment (Mini-cog) scores\u0026gt;0; (5) postoperative hospital stay\u0026thinsp;\u0026ge;\u0026thinsp;3 days; (6) vital signs are stable and can cooperate with the completion of the relevant assessment; (7) have good language expression ability, communicate with the investigators without obstacles; Voluntary participation in the study and signed informed consent. Elimination criteria were as follows: (1) participants with a diagnosis of dementia; (2) history of severe neurological or psychiatric disease; (3) serious audiovisual impairments that impacted assessments. Patients were classified into four groups, group A: neither frail nor cognitive impairment group ; group B: cognitive frailty group ; group C: only frailty ; group D: only cognitive impairment group.\u003c/p\u003e\n \u003cp\u003eThe trial was registered in the Chinese Clinical Trial Registry in 17/05/2023, ChiCTR2300071535 and approved by the Ethics Committee of Guangdong Provincial Hospital of Chinese Medical (BE2022-165‐01). We followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guidelines. All participants provided written informed consent prior to enrolment.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\n \u003ch2\u003eCalculating ample size\u003c/h2\u003e\n \u003cp\u003eThis study calculates the sample size based on the formula n=[Z\u0026sup2;\u0026alpha;/2\u0026middot;P(1-P)]/\u0026beta;\u0026sup2;, where the significance level \u0026alpha; is set at 0.05, resulting in Z\u0026alpha;/2\u0026thinsp;=\u0026thinsp;1.96. The parameter \u003cem\u003eP\u003c/em\u003e represents the estimated probability, considering relevant literature indicating a 14.3%[\u003cspan class=\"CitationRef\"\u003e12\u003c/span\u003e] incidence rate of cognitive frailty among elderly hospitalized patients. The margin of error, \u0026beta;, is set at 5%. Accounting for a potential 10% sample loss, the minimum required sample size is determined to be 207 cases. A total of 253 cases were collected in our study, meeting the sample size requirements.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\n \u003ch2\u003eDemographic characteristics and clinical data\u003c/h2\u003e\n \u003cp\u003eDemographic characteristics and clinical data were collected from each participant before surgery. Age-adjusted charlson comorbidity index ( aCCI ) was used to grade comorbidities[\u003cspan class=\"CitationRef\"\u003e13\u003c/span\u003e], activities of daily living ( using the BI, Barthel index)[\u003cspan class=\"CitationRef\"\u003e14\u003c/span\u003e], nutritional status ( using the NRS2002, nutritional risk screening 2002)[\u003cspan class=\"CitationRef\"\u003e15\u003c/span\u003e], pain ( using the NRS, numerical rating scale)[\u003cspan class=\"CitationRef\"\u003e16\u003c/span\u003e], sleep quality ( using the AIS, Athens Insomnia Scale)[\u003cspan class=\"CitationRef\"\u003e17\u003c/span\u003e], depression ( using the PHQ, Patient Health Questionnaire)[\u003cspan class=\"CitationRef\"\u003e18\u003c/span\u003e], and were uniformly assessed by trained research nurses. Surgery-related data was collected from each participant after surgery, including ASA score, surgery category, surgery time, use analgesia pump, preemptive analgesis,and intraoperative blood loss.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\n \u003ch2\u003eCriteria of cognitive frailty\u003c/h2\u003e\n \u003cp\u003eAccording to the criteria, which was proposed jointly by the International Academy on Nutrition and Aging ( I.A.N.A ) and the International Association Gerontology and Geriatrics ( I.A.G.G ) in 2013, cognitive frailty (CF) was defined as simultaneous existence of both physical frailty and cognitive impairment without dementia[\u003cspan class=\"CitationRef\"\u003e6\u003c/span\u003e]. Below are the assessment methods for frailty and cognitive function:\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\n \u003ch2\u003eFrailty measures\u003c/h2\u003e\n \u003cp\u003ePhysical frailty was assessed based on the FRAIL scale, which consists of five items (fatigue, resistance, walking, illness, and loss of weight)[\u003cspan class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e20\u003c/span\u003e]. The Frail scale scores range from 0 to 5, presence of \u0026ge;\u0026thinsp;3 denotes frailty, 1\u0026ndash;2 pre-frailty, and 0 robust. Fatigue and weight loss are biological factors, while resistance and walking ability represent functional aspects, with disease representing the accumulation of deficits. The Frail Scale was measured at baseline.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\n \u003ch2\u003eCognitive function measures\u003c/h2\u003e\n \u003cp\u003eCognitive function was assessed using the Chinese version of the Montreal Cognitive Assessment (MoCA-Chinese Beijing version) scale[\u003cspan class=\"CitationRef\"\u003e21\u003c/span\u003e]. Patients with MoCA\u0026thinsp;\u0026ge;\u0026thinsp;26 were screened as cognitively normal, and patients with MoCA\u0026thinsp;\u0026le;\u0026thinsp;25 were screened as with cognitive impairment. To counterbalance the effect of lower education, 1 point was added to the final score of those individuals with \u0026lt;12 years of education. Furthermore, we performed several methods to promote the assessment quality and methodological reliability, which includes the following: (1) The researchers who conducted MOCA assessment have passed the assessment on the official website and have been certified for the assessment; (2) All the tests were conducted under the direction of the staff who were trained by the neuropsychologists before the study; (3) Collected by the same researcher to avoid measurement bias. The MoCA scale was measured at baseline.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\n \u003ch2\u003eOutcome measures\u003c/h2\u003e\n \u003cp\u003eThe primary outcome of the study was postoperative complications within (5\u0026thinsp;\u0026plusmn;\u0026thinsp;2) days after surgery. These complications were assessed using the Clavien\u0026ndash;Dindo classification system (CD)[\u003cspan class=\"CitationRef\"\u003e22\u003c/span\u003e]. Any events with a grade\u0026thinsp;\u0026ge;\u0026thinsp;2 were categorized as complications, with Grade II mainly including postoperative infections, hypoalbuminemia, and electrolyte disturbances. Severe complications are grades 3\u0026ndash;5 (CD3 complications), mainly including cardiovascular-related complications (heart failure, arrhythmia, myocardial infarction, cardiac arrest, angina pectoris), respiratory-related complications (respiratory failure), neurological complications (stroke, cerebral hemorrhage, delirium), thrombotic complications (deep vein thrombosis, pulmonary embolism) and ICU admission.\u003c/p\u003e\n \u003cp\u003eThe secondary outcomes included: (1) Mobility disability. Mobility disability was assessed using the Barthel Index (BI) within (5\u0026thinsp;\u0026plusmn;\u0026thinsp;2) days after surgery, with a BI score\u0026thinsp;\u0026le;\u0026thinsp;60 indicating \u0026quot;yes\u0026quot;[\u003cspan class=\"CitationRef\"\u003e23\u003c/span\u003e]; (2) Prolonged hospital stay. The mean length of hospital stay for patients in this study was (12.30\u0026thinsp;\u0026plusmn;\u0026thinsp;7.54) days. Following precedent from prior studies, prolonged hospital stay was defined as a length of stay exceeding 75% of the patients\u0026apos; actual hospital stay duration (from admission to discharge)[\u003cspan class=\"CitationRef\"\u003e24\u003c/span\u003e]. Therefore, in this study, prolonged hospital stay was defined as \u0026gt;\u0026thinsp;16 days; (3) Reoperation; (4) 90-day readmission.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\n \u003ch2\u003eStatistical analysis\u003c/h2\u003e\n \u003cp\u003eData were statistically analyzed using SPSS version 25.0 professional statistical software and all the count data are expressed as numbers and percentage (%), and chi-square or Fisher\u0026rsquo;s exact tests were used for comparisons between groups. Measurement data was expressed as mean (x̄ ± s) standard deviation and those subject to normal distribution between two groups were compared with independent sample t-test. Comparison among the group was analyzed by one-way analysis of variance (ANOVA). Non-normally distributed measures were expressed as median [M ( P25, P75)] and compared between the two groups using the Mann-Whitney U-test. The association between preoperative cognitive frailty and postoperative adverse outcomes was analyzed using univariate and multivariate logistic regression. Then, variables with \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.1 in the univariate logistic regression analysis, along with clinically significant variables, were included in the multivariable logistic regression analysis. The difference was considered statistically significant at \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eBaseline characteristics\u003c/h2\u003e \u003cp\u003eA total of 324 patients were assessed for eligibility, among which 253 patients were finally analyzed, with 77(30.4%) in group A (neither frail nor cognitive impairment group), 45(17.8%) in group B (cognitive frailty group), 24(9.5%) in group C (only frailty) and 107(42.3%) in group D (only cognitive impairment group). The enrollment flow diagram is shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e .\u003c/p\u003e \u003cp\u003eDemographic characteristics and clinical characteristics were shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. There were differences in gender, age, marital status, education, pre-retirement occupation, history of stress (within 1 year), aCCI, preoperative assessment of activities of daily living, nutritional status, sleep quality and depression among the four groups (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). No statistically significant difference between four groups was noted in the surgery information(\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Only ASA score was different among the four groups ( \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05 ).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCharacteristics of study participants(n\u0026thinsp;=\u0026thinsp;253)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOverall\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;253)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNeither cognitive decline nor frailty (n\u0026thinsp;=\u0026thinsp;77)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eOnly frailty\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;24)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eOnly cognitive decline\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;107)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eCognitive frailty\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;45)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.048\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e102 (40.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e37 (48.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7 (29.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e35 (32.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e23 (51.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e151 (59.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e40 (51.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17 (70.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e72 (67.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e22 (48.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge, years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e69.0 (65.0, 73.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e68.0 (65.0, 73.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e68.0 (65.0, 72.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e69.0 (65.0, 72.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e73.0 (70.0, 78.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarital status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.004\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarriage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e228 (90.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e73 (94.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16 (66.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e97 (90.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e42 (93.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDivorced or widowed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e25 ( 9.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4 (5.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8 (33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10 (9.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3 (6.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI, kg/m\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e23.9\u0026thinsp;\u0026plusmn;\u0026thinsp;3.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e23.9\u0026thinsp;\u0026plusmn;\u0026thinsp;3.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23.9\u0026thinsp;\u0026plusmn;\u0026thinsp;3.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e24.2\u0026thinsp;\u0026plusmn;\u0026thinsp;3.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e23.2\u0026thinsp;\u0026plusmn;\u0026thinsp;3.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.432\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBelow Primary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e86 (34.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7 (9.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (8.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e51 (47.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e26 (57.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMeddle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e76 (30.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e21 (27.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8 (33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e36 (33.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e11 (24.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e69 (27.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e37 (48.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9 (37.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e17 (15.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e6 (13.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUniversity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e22 ( 8.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12 (15.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5 (20.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3 (2.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2 (4.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePre-retirement occupation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.019\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePhysical strength\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e109 (43.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e24 (31.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7 (29.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e60 (56.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e18 (40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBoth mental and physical strength\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e91 (36.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e34 (44.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10 (41.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e32 (29.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e15 (33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMental strength\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e53 (20.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e19 (24.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7 (29.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e15 (14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e12 (26.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSmoking status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.671\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e216 (85.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e65 (84.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e19 (79.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e94 (87.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e38 (84.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e37 (14.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12 (15.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5 (20.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e13 (12.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e7 (15.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlcohol status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.687\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e229 (90.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e72 (93.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21 (87.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e96 (89.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e40 (88.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e24 ( 9.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5 (6.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (12.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11 (10.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5 (11.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMultiple medication\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.764\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e233 (92.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e71 (92.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22 (91.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e100 (93.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e40 (88.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e20 ( 7.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6 (7.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (8.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7 (6.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5 (11.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHistory of stress(within 1 year)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.015\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e155 (61.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e55 (71.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14 (58.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e67 (62.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e19 (42.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e98 (38.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e22 (28.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10 (41.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e40 (37.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e26 (57.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eaCCI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4.0 (3.0, 5.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.0 (2.0, 5.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.0 (3.0, 5.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.0 (2.0, 5.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5.0 (4.0, 6.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eActivities of daily living\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e95.0 (90.0, 100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e100.0 (95.0, 100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e95.0 (83.8, 96.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e95.0 (95.0, 100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e90.0 (70.0, 95.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNutritional status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.0 (0.0, 1.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.0 (0.0, 1.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.0 (0.0, 2.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.0 (0.0, 0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.0 (0.0, 3.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.0 (0.0, 2.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.0 (0.0, 1.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.0 (0.0, 2.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.0 (0.0, 3.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.0 (0.0, 2.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.387\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSleep quality\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.0 (1.0, 7.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.0 (1.0, 6.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.0 (1.8, 4.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.0 (1.0, 7.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e6.0 (3.0, 8.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.006\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDepression\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.0 (1.0, 4.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.0 (0.0, 3.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.0 (1.0, 4.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.0 (1.0, 4.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5.0 (2.0, 9.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eASA score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLevel 2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e178 (70.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e63 (81.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16 (66.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e80 (74.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e19 (42.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLevel 3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e75 (29.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14 (18.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8 (33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e27 (25.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e26 (57.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSurgery category\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.16\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAbdomen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e121 (47.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e41 (53.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11 (45.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e44 (41.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e25 (55.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLimbs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e82 (32.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e25 (32.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6 (25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e42 (39.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e9 (20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSpine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e50 (19.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11 (14.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7 (29.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e21 (19.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e11 (24.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSurgery time, min\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e140.0 (102.0, 196.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e145.0 (100.0, 188.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e130.5 (103.8, 178.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e131.0 (101.0, 184.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e170.0 (115.0, 218.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.262\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUse analgesia pump\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.769\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e20 ( 7.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6 (7.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (8.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7 (6.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5 (11.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e233 (92.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e71 (92.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22 (91.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e100 (93.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e40 (88.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreemptive analgesis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.377\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e134 (53.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e43 (55.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12 (50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e51 (47.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e28 (62.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e119 (47.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e34 (44.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12 (50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e56 (52.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e17 (37.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntraoperative blood loss, mL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e50.0 (20.0, 100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e50.0 (20.0, 50.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e45.2 (27.5, 100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e50.0 (30.0, 100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e50.0 (30.0, 100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.239\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003e*BMI, body mass index; aCCI, age-adjusted Charlson Co-morbidity index; Activities of daily living was assessed using the BI (Barthel index); Nutritional status was assessed using the NRS2002 (nutritional risk screening 2002); Pain was assessed using the NRS (numerical rating scale); Sleep quality was assessed using the AIS (Athens Insomnia Scale); Depression was assessed using the PHQ (Patient Health Questionnaire); ASA: American Society of Anesthesiologists\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eClassification of post-operative complications\u003c/h2\u003e \u003cp\u003eOne hundred patients experienced a complication classified as Clavien-Dindo grade\u0026thinsp;\u0026ge;\u0026thinsp;II, with 18 elderly patients experienced CD3 complications(grades\u0026thinsp;\u0026ge;\u0026thinsp;III). Figure\u0026nbsp;2 and Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e3\u003c/span\u003e illustrate the frequencies of Grade II and CD3 complications respectively, among four groups of cognitive frailty during the study.\u003c/p\u003e\u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eAssociations of cognitive frailty with post-operative outcomes\u003c/h2\u003e \u003cp\u003eThe differences in postoperative complications, postoperative mobility disability, prolonged hospitalization time and reoperation among the four groups (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). No significant differences in the 90-day readmission among the four groups (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.092) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eShort-term postoperative outcomes\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOverall\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;253)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNeither cognitive decline nor frailty (n\u0026thinsp;=\u0026thinsp;77)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eOnly frailty\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;24)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eOnly cognitive decline\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;107)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eCognitive frailty(n\u0026thinsp;=\u0026thinsp;45)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003epostoperative complication (CD\u0026thinsp;\u0026ge;\u0026thinsp;II)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e153 (60.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e63 (81.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12 (50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e67 (62.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e11 (24.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e100 (39.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14 (18.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12 (50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e40 (37.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e34 (75.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCD3 complication\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e235 (92.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e76 (98.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22 (91.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e103 (96.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e34 (75.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e18 ( 7.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (1.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (8.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4 (3.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e11 (24.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePost infection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e232 (91.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e77 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22 (91.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e101 (94.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e32 (71.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e21 ( 8.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (8.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e6 (5.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e13 (28.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypoalbuminemia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e217 (85.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e71 (92.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20 (83.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e98 (91.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e28 (62.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e36 (14.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 (7.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (16.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e9 (8.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e17 (37.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eElectrolyte disturbances\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e186 (73.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e69 (89.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17 (70.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e78 (72.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e22 (48.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e67 (26.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8 (10.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7 (29.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e29 (27.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e23 (51.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMobility disability\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e209 (82.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e69 (89.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18 (75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e95 (88.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e27 (60)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e44 (17.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8 (10.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6 (25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e12 (11.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e18 (40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProlonged\u0026nbsp;hospital\u0026nbsp;stay\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.008\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e217 (85.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e70 (90.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21 (87.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e95 (88.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e31 (68.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e36 (14.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (9.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (12.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e12 (11.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e14 (31.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReoperation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.285\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e240 (94.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e74 (96.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23 (95.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e103 (96.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e40 (88.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e13 ( 5.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (3.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (4.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4 (3.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5 (11.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e90-day readmission\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.092\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e205 (81.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e59 (76.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e19 (79.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e94 (87.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e33 (73.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e48 (19.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18 (23.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5 (20.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e13 (12.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e12 (26.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e*Mobility disability was assessed using the ADL (activities of daily living).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eAssociations of cognitive frailty with post-operative outcomes\u003c/h2\u003e \u003cp\u003eIn the univariate logistic regression analysis of adverse postoperative outcomes, differences were observed among gender, age, BMI, education, smoking status, history of stress(within 1 year), aCCI, NRS, NRS2002, ADL, ASA score, surgery category and surgery time(\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.1). ( Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e )\u003c/p\u003e \u003cp\u003eMultivariate logistic regression analysis revealed that cognitive frailty increased the incidence of postoperative complications, CD3 complications, mobility disability and prolonged hospitalization in the elderly in the adjusted model 1 (adjusted age, marital status, BMI, education, pre-retirement occupation, smoking and drinking) and the adjusted model 2 (adding multiple medication, history of stress(within 1 year), aCCI, NRS, NRS2002, ADL and PHQ on the basis of adjusted model 1). Cognitive frailty increased the incidence of postoperative complications, CD3 complications and prolonged hospital stay in the elderly in the adjusted model 3 (on the basis of the adjusted model 2, increase ASA score, surgery category, and surgery time). Compared with the elderly with only preoperative frailty or cognitive impairment, the elderly with preoperative cognitive frailty have a higher risk of postoperative adverse outcomes. ( Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e )\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eUnivariate logistic regression of postoperative outcomes\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003ePostoperative complication\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eCD3 complication\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003eMobility disability\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003eProlonged\u0026nbsp;hospital\u0026nbsp;stay\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOR (95%CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eOR (95%CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eOR (95%CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eOR (95%CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex (Female)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.63 (0.38\u0026thinsp;~\u0026thinsp;1.06)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.081\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.63 (0.38\u0026thinsp;~\u0026thinsp;1.06)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.081\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.62 (0.32\u0026thinsp;~\u0026thinsp;1.21)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.164\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.94 (0.46\u0026thinsp;~\u0026thinsp;1.92)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.858\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.09 (1.04\u0026thinsp;~\u0026thinsp;1.14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.09 (1.04\u0026thinsp;~\u0026thinsp;1.14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.06 (1.01\u0026thinsp;~\u0026thinsp;1.12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.029\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e1.02 (0.96\u0026thinsp;~\u0026thinsp;1.08)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.477\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarriage (Divorced or widowed)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.47 (0.64\u0026thinsp;~\u0026thinsp;3.36)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.363\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.47 (0.64\u0026thinsp;~\u0026thinsp;3.36)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.363\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.29 (0.46\u0026thinsp;~\u0026thinsp;3.66)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.631\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.5 (0.11\u0026thinsp;~\u0026thinsp;2.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.357\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.94 (0.87\u0026thinsp;~\u0026thinsp;1.01)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.083\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.94 (0.87\u0026thinsp;~\u0026thinsp;1.01)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.083\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.97 (0.88\u0026thinsp;~\u0026thinsp;1.07)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.546\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.95 (0.85\u0026thinsp;~\u0026thinsp;1.05)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.296\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducation\u003c/p\u003e \u003cp\u003e(Meddle)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.72 (0.39\u0026thinsp;~\u0026thinsp;1.35)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.305\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.72 (0.39\u0026thinsp;~\u0026thinsp;1.35)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.305\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.85 (0.39\u0026thinsp;~\u0026thinsp;1.86)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.689\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.52 (0.2\u0026thinsp;~\u0026thinsp;1.37)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.187\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducation\u003c/p\u003e \u003cp\u003e(High)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.37 (0.19\u0026thinsp;~\u0026thinsp;0.73)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.004\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.37 (0.19\u0026thinsp;~\u0026thinsp;0.73)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.004\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.57 (0.24\u0026thinsp;~\u0026thinsp;1.36)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.202\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.67 (0.27\u0026thinsp;~\u0026thinsp;1.71)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.408\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducation\u003c/p\u003e \u003cp\u003e(University)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.73 (0.28\u0026thinsp;~\u0026thinsp;1.87)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.507\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.73 (0.28\u0026thinsp;~\u0026thinsp;1.87)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.507\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.18 (0.02\u0026thinsp;~\u0026thinsp;1.43)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.105\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e2.4 (0.83\u0026thinsp;~\u0026thinsp;6.96)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.107\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePre-retirement occupation\u003c/p\u003e \u003cp\u003e(Both mental and physical strength )\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.35 (0.76\u0026thinsp;~\u0026thinsp;2.38)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.307\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.35 (0.76\u0026thinsp;~\u0026thinsp;2.38)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.307\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.86 (0.41\u0026thinsp;~\u0026thinsp;1.83)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.698\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e1.23 (0.55\u0026thinsp;~\u0026thinsp;2.74)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.607\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePre-retirement occupation\u003c/p\u003e \u003cp\u003e(Mental strength)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.27 (0.65\u0026thinsp;~\u0026thinsp;2.49)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.27 (0.65\u0026thinsp;~\u0026thinsp;2.49)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.97 (0.41\u0026thinsp;~\u0026thinsp;2.32)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.943\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e1.21 (0.47\u0026thinsp;~\u0026thinsp;3.08)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.695\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSmoking\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.92 (0.45\u0026thinsp;~\u0026thinsp;1.89)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.92 (0.45\u0026thinsp;~\u0026thinsp;1.89)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.97 (0.38\u0026thinsp;~\u0026thinsp;2.49)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.946\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e1.85 (0.77\u0026thinsp;~\u0026thinsp;4.46)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.169\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDrinking\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.82 (1.18\u0026thinsp;~\u0026thinsp;6.73)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.019\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.82 (1.18\u0026thinsp;~\u0026thinsp;6.73)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.019\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.7 (0.2\u0026thinsp;~\u0026thinsp;2.45)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.572\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e2.21 (0.81\u0026thinsp;~\u0026thinsp;6.01)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.12\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMultiple medication\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.28 (0.51\u0026thinsp;~\u0026thinsp;3.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.603\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.28 (0.51\u0026thinsp;~\u0026thinsp;3.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.603\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.88 (0.25\u0026thinsp;~\u0026thinsp;3.14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.841\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.3 (0.04\u0026thinsp;~\u0026thinsp;2.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.245\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHistory of stress(within 1 year)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.35 (1.39\u0026thinsp;~\u0026thinsp;3.95)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.35 (1.39\u0026thinsp;~\u0026thinsp;3.95)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.23 (0.63\u0026thinsp;~\u0026thinsp;2.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.549\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e1.71 (0.84\u0026thinsp;~\u0026thinsp;3.48)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.137\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eASA score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.64 (0.95\u0026thinsp;~\u0026thinsp;2.84)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.075\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.64 (0.95\u0026thinsp;~\u0026thinsp;2.84)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.075\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.79 (0.9\u0026thinsp;~\u0026thinsp;3.56)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.095\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e2.81 (1.37\u0026thinsp;~\u0026thinsp;5.77)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.005\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSurgery category\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.25 (0.13\u0026thinsp;~\u0026thinsp;0.47)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.36 (0.18\u0026thinsp;~\u0026thinsp;0.72)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.004\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.99 (0.51\u0026thinsp;~\u0026thinsp;1.92)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.979\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.68 (0.34\u0026thinsp;~\u0026thinsp;1.39)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.294\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSurgery time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.36 (0.18\u0026thinsp;~\u0026thinsp;0.72)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.004\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (1\u0026thinsp;~\u0026thinsp;1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.948\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.01 (1\u0026thinsp;~\u0026thinsp;1.01)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e1.01 (1.01\u0026thinsp;~\u0026thinsp;1.02)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eaCCI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (1\u0026thinsp;~\u0026thinsp;1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.948\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.39 (1.19\u0026thinsp;~\u0026thinsp;1.63)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.11 (0.92\u0026thinsp;~\u0026thinsp;1.33)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.285\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e1.09 (0.89\u0026thinsp;~\u0026thinsp;1.32)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.407\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNutritional status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.39 (1.19\u0026thinsp;~\u0026thinsp;1.63)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.52 (1.2\u0026thinsp;~\u0026thinsp;1.94)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.28 (0.96\u0026thinsp;~\u0026thinsp;1.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.094\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e1.5 (1.12\u0026thinsp;~\u0026thinsp;2.02)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.006\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.52 (1.2\u0026thinsp;~\u0026thinsp;1.94)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.89 (0.73\u0026thinsp;~\u0026thinsp;1.08)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.219\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.16 (0.92\u0026thinsp;~\u0026thinsp;1.47)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.214\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e1.04 (0.8\u0026thinsp;~\u0026thinsp;1.35)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.787\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSleep quality\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.89 (0.73\u0026thinsp;~\u0026thinsp;1.08)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.219\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.02 (0.96\u0026thinsp;~\u0026thinsp;1.09)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.487\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.03 (0.95\u0026thinsp;~\u0026thinsp;1.11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e1.02 (0.94\u0026thinsp;~\u0026thinsp;1.11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.675\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eActivities of daily living\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.02 (0.96\u0026thinsp;~\u0026thinsp;1.09)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.487\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.97 (0.95\u0026thinsp;~\u0026thinsp;0.99)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.96 (0.94\u0026thinsp;~\u0026thinsp;0.98)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e1 (0.98\u0026thinsp;~\u0026thinsp;1.03)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.719\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDepression\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.97 (0.95\u0026thinsp;~\u0026thinsp;0.99)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.14 (1.05\u0026thinsp;~\u0026thinsp;1.24)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.04 (0.95\u0026thinsp;~\u0026thinsp;1.15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e1.05 (0.95\u0026thinsp;~\u0026thinsp;1.16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.339\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMultivariate logistic regression of postoperative outcomes\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eModel\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eExposure\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c6\" namest=\"c3\"\u003e \u003cp\u003ePostoperative Outcomes\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePostoperative complication\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCD3 complication\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMobility disability\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eProlonged\u0026nbsp;hospital\u0026nbsp;stay\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNeither cognitive decline nor frailty\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1(Ref)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1(Ref)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1(Ref)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1(Ref)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnadjusted (OR,95%, CI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCognitive frailty\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13.91 (5.69\u0026thinsp;~\u0026thinsp;33.98)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24.59 (3.05\u0026thinsp;~\u0026thinsp;198.14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7.31 (2.75\u0026thinsp;~\u0026thinsp;19.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4.52 (1.66\u0026thinsp;~\u0026thinsp;12.29)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOnly frailty\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.5 (1.68\u0026thinsp;~\u0026thinsp;12.08)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.91 (0.6\u0026thinsp;~\u0026thinsp;79.82)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.63 (0.75\u0026thinsp;~\u0026thinsp;9.23)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.43 (0.34\u0026thinsp;~\u0026thinsp;6.02)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOnly cognitive decline\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.69 (1.34\u0026thinsp;~\u0026thinsp;5.41)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.95 (0.32\u0026thinsp;~\u0026thinsp;26.94)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.15 (0.42\u0026thinsp;~\u0026thinsp;3.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.26 (0.47\u0026thinsp;~\u0026thinsp;3.37)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAdjusted I\u003c/p\u003e \u003cp\u003e(OR,95%, CI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCognitive frailty\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.6 (3.8\u0026thinsp;~\u0026thinsp;29.59)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e30.72 (2.65\u0026thinsp;~\u0026thinsp;356.42)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6.01 (1.91\u0026thinsp;~\u0026thinsp;18.89)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e6.74 (1.95\u0026thinsp;~\u0026thinsp;23.24)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOnly frailty\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.29 (1.75\u0026thinsp;~\u0026thinsp;15.95)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.21 (0.45\u0026thinsp;~\u0026thinsp;85.39)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.18 (0.8\u0026thinsp;~\u0026thinsp;12.62)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.15 (0.24\u0026thinsp;~\u0026thinsp;5.56)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOnly cognitive decline\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.72 (1.19\u0026thinsp;~\u0026thinsp;6.22)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.47 (0.38\u0026thinsp;~\u0026thinsp;52.87)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.99 (0.33\u0026thinsp;~\u0026thinsp;2.96)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.72 (0.55\u0026thinsp;~\u0026thinsp;5.41)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAdjusted II\u003c/p\u003e \u003cp\u003e(OR,95%, CI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCognitive frailty\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.9 (2.25\u0026thinsp;~\u0026thinsp;21.17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e32.53 (2.17\u0026thinsp;~\u0026thinsp;486.79)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5.41 (1.33\u0026thinsp;~\u0026thinsp;21.98)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e10.67 (2.49\u0026thinsp;~\u0026thinsp;45.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOnly frailty\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.86 (1.52\u0026thinsp;~\u0026thinsp;15.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8.64 (0.52\u0026thinsp;~\u0026thinsp;143.81)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.96 (0.69\u0026thinsp;~\u0026thinsp;12.68)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.16 (0.22\u0026thinsp;~\u0026thinsp;6.13)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOnly cognitive decline\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.83 (1.17\u0026thinsp;~\u0026thinsp;6.81)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.96 (0.4\u0026thinsp;~\u0026thinsp;88.15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.88 (0.27\u0026thinsp;~\u0026thinsp;2.84)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.11 (0.63\u0026thinsp;~\u0026thinsp;7.07)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAdjusted III\u003c/p\u003e \u003cp\u003e(OR,95%, CI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCognitive frailty\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16.84 (4.54\u0026thinsp;~\u0026thinsp;62.37)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e49.01 (2.42\u0026thinsp;~\u0026thinsp;990.78)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.95 (1.01\u0026thinsp;~\u0026thinsp;24.23)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e10.95 (1.95\u0026thinsp;~\u0026thinsp;61.45)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOnly frailty\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.86 (2.12\u0026thinsp;~\u0026thinsp;29.12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17.18 (0.77\u0026thinsp;~\u0026thinsp;382.89)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.67 (0.9\u0026thinsp;~\u0026thinsp;24.28)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.3 (0.21\u0026thinsp;~\u0026thinsp;8.05)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOnly cognitive decline\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.22 (1.62\u0026thinsp;~\u0026thinsp;11.02)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8.26 (0.45\u0026thinsp;~\u0026thinsp;152.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.9 (0.24\u0026thinsp;~\u0026thinsp;3.42)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.9 (0.72\u0026thinsp;~\u0026thinsp;11.74)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e*Model 1: adjusted for gender, age, marital status, BMI, education, Pre-retirement occupation, Smoking status, alcohol status\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eModel 2: adjusted Model 1 plus multiple medication, history of stress(within 1 year), aCCI, NRS, NRS2002, ADL, PHQ\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eModel 3:adjusted Model 2 plus ASA score, surgery category, and surgery time\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis is the first study to explore the association between preoperative cognitive frailty and adverse outcomes in elderly patients undergoing surgery under general anesthesia. Our prospective study has found that cognitive frailty is an independent risk factor for adverse postoperative outcomes in elderly patients undergoing general anesthesia. Besides, elderly patients with preoperative cognitive frailty have poor postoperative recovery, which includes a high incidence of postoperative complications, mobility disability and prolonged hospital stay.\u003c/p\u003e \u003cp\u003eIn our study, the prevalence of preoperative cognitive frailty in elderly patients undergoing elective orthopedic or abdominal general anesthesia surgery was 17.79%, which was higher than the results of Ma[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e], Brigola[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e], and Yu[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e] in the community elderly (2.9%, 10.9%, 8.7%). This may be due to the lack of uniform diagnostic criteria and assessment methods for cognitive frailty, as well as significant differences in the different study designs. In addition, some scholars have found that the prevalence of cognitive frailty in clinical settings can be as high as 37.40%-50.9%[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. It may be attributed to the impact of the disease on elderly patients undergoing elective general anesthesia surgery, resulting in a decrease in physiological reserve, low immunity and stress response ability, which increases the incidence of cognitive frailty.\u003c/p\u003e \u003cp\u003eWe found that cognitive frailty was an independent risk factor for postoperative complications in elderly patients undergoing general anesthesia. Multivariate logistic regression analysis showed that the elderly in the preoperative cognitive frailty group were more likely to have postoperative complications and CD3 complications than those in the only frailty group or the only cognitive impairment group. A review has shown that physical frailty and cognitive dysfunction have similar pathophysiological mechanisms, such as mitochondrial dysfunction and oxidative stress, inflammatory response, and endocrine disorders[\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. Frailty is a geriatric syndrome resulting from age-related cumulative decline across multiple physiologic systems, impaired homeostatic reserve, and reduced capacity to resist stress[\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Prior work has shown that frail is an important factor in risk stratification and outcome prediction[\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e], and it was associated with an increased risk for postoperative complications, length of stay health care burdens, and other survival outcomes[\u003cspan additionalcitationids=\"CR35\" citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. Cognitive dysfunction refers to different degrees of cognitive impairment stemming from various causes, and it is also known to be associated with increased risk of adverse events post operative, complications of coexisting medical conditions, decreased mobility, increased healthcare utilization, and substantial caregiver burden[\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. Cognitive frailty is the superposition of the above two. The coexistence of the two can accelerate the decline of physical and cognitive functions and form a vicious cycle, bringing more serious cumulative effects on the body[\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. This is consistent with the results of the analysis in this study, showing that the elderly with cognitive frailty had the highest risk of adverse postoperative outcomes compared with the purely frailty or purely cognitive impairment group.\u003c/p\u003e \u003cp\u003eDifferent from previous research[\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e], multivariate logistic regression analysis in our study revealed no significant association between frailty and cognitive impairment with postoperative mobility disability or prolonged hospital stay. This could be attributed to the categorization of different states of frailty and cognitive impairment into four distinct groups, where patients with cognitive frailty were no longer classified into the frailty or cognitive impairment groups, resulting in a relatively lower incidence rate of frail. Additionally, it may also be influenced by the use of different assessment scales for frailty and cognitive impairment.\u003c/p\u003e \u003cp\u003eA substantial amount of research has found that association between cognitive frailty in community-dwelling older adults and various adverse outcomes[\u003cspan additionalcitationids=\"CR44\" citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e]. Many communities have incorporated cognitive frailty into their assessments. However, due to the unclear impact of preoperative cognitive frailty on postoperative recovery in the elderly, many countries have not yet included it in clinical practice assessments. Our study indicates that preoperative cognitive frailty is associated with adverse postoperative outcomes in elderly patients. It suggests that healthcare professionals need to pay more attention to cognitive frailty in elderly patients. Besides, it also provides clinical evidence for early screening and intervention for cognitive frailty.\u003c/p\u003e \u003cp\u003eOne strength of this study is that the research object was elderly patients undergoing general anesthesia surgery. This is the first study to investigate the relationship between preoperative cognitive frailty and adverse outcomes in elderly patients undergoing elective orthopedic or abdominal general anesthesia surgery. Previous studies on cognitive frailty have mainly focused on the community, and there are few studies on the elderly hospitalized, especially the elderly undergoing surgery. The elderly are more vulnerable to stressors due to their reduced physiological reserves and decreased ability to maintain balance in the body, and surgery as a major physical and psychological blow will deplete the elderly 's limited reserves and lead to decompensation[\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e]. In addition, the type of the surgery included in this study focused on the high-risk surgery group rather than extensively assessing the risk of different procedures. Due to orthopedic and abdominal general anesthesia surgery as the most common surgical procedures in the elderly. So, this study selected the higher-risk surgical methods in these two types of surgery to explore the impact of cognitive frailty on elderly patients undergoing general anesthesia surgery.\u003c/p\u003e \u003cp\u003eThere are some limitations to our study. First, this is a single-center study, which limits the generalizability of its conclusions. Second, unmeasured confounders may exist because of the observational nature of this research. Third, some of the self-reported parameters are subjective in nature and may introduce informational bias. Fourth, although the cognitive frailty group had a higher risk of CD3 complications (15.6% vs. 0%) than the fit group, the small number of patients in each group and low incidence rate of adverse outcomes may limit the statistical power in detecting the significance of the in-group differences in this study. Finally, the long term effects of cognitive frailty on postoperative recovery in elderly patients were not observed. Hence, further multi-centre, large sample trials are needed to investigate the long-term impacts of cognitive frailty on postoperative recovery in elderly patients and explore the effective treatment for cognitive frailty.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eAlthough screening cognitive frailty is not routine clinical practice for hospitalized patients, resulting in neglect of the potential risk of cognitive frailty by medical staff, our study indicates the cumulative effects of combined frailty and cognitive impairment on adverse outcomes and demonstrating the importance of cognitive frailty to identify patients at high risk for adverse surgical outcomes, and highlighting the need for future studies to develop interventions, such as preoperative prehabilitation to mitigate this risk. It is very important that clinicians pay more attention to these elderly with cognitive frailty.\u003c/p\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eAbbrevlations\u003c/h2\u003e \u003cp\u003eMoCA: Montreal Cognitive Assessment; OR: odds ratio; CI:confidence interval; BMI: body mass index; aCCI: age-adjusted Charlson Co-morbidity index; BI: Barthel index; NRS2002: nutritional risk screening 2002; NRS:numerical rating scale; AIS: Athens Insomnia Scale; PHQ: Patient Health Questionnaire; ASA: American Society of Anesthesiologist.\u003c/p\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor\u0026rsquo;s contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors contributed intellectually to the study. They substantially contributed to the conception or design of the work and drafted the manuscript. Wei and Fang oversaw quality control and provided protocol guidance for the study. All authors were involved in information collection, data entry, and manuscript writing. Data analysis was conducted by Fang. All authors have read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was supported by The Institute of Science and Technology of the National Health Commission of the People\u0026rsquo;s Republic of China (No.2021KYSHX016010201). Commercial funding was not received.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data collected in this study is not publicly available because the participants did not consent to the public release of their data. However, the corresponding author may provide further analytical information and supporting data upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and conset to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthics approved has been received from the Ethics Committee of Guangdong Provincial Hospital of Chinese Medical (Ethics Document Batch number: BE2022‐165‐01). The study was carried out in compliance with the Helsinki Declaration, and all the participants provided written informed consent prior to enrolment. We followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guidelines.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor details\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e1\u003c/sup\u003eState Key Laboratory of Traditional Chinese Medicine Syndrome, the Second Clinical Medical School of Guangzhou University of Chinese Medicine, Guangzhou 510006, P. R China\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e2\u003c/sup\u003eDepartment of Neurology, the Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510120, P. R China\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e3\u003c/sup\u003eCollege of Nursing, Hunan University of Traditional Chinese Medicine, Changsha 410208, P. R China\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e4\u003c/sup\u003eState Key Laboratory of Traditional Chinese Medicine Syndrome, the Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120, P. R China\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eWeiser TG, Haynes AB, Molina G, Lipsitz SR, Esquivel MM, Uribe-Leitz T, Fu R, Azad T, Chao TE, Berry WR, et al. Estimate of the global volume of surgery in 2012: an assessment supporting improved health outcomes. Lancet (London England). 2015;385(Suppl 2):S11.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eStory DA. Postoperative mortality and complications. 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NUTR J. 2019;18(1):33.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMa Y, Li X, Pan Y, Zhao R, Wang X, Jiang X, Li S. Cognitive frailty predicting death and disability in Chinese elderly. NEUROL RES. 2021;43(10):815\u0026ndash;22.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBrigola AG, Ottaviani AC, Alexandre TDS, Luchesi BM, Pavarini SCI. Cumulative effects of cognitive impairment and frailty on functional decline, falls and hospitalization: A four-year follow-up study with older adults. ARCH GERONTOL GERIAT. 2020;87:104005.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYu R, Morley JE, Kwok T, Leung J, Cheung O, Woo J. The Effects of Combinations of Cognitive Impairment and Pre-frailty on Adverse Outcomes from a Prospective Community-Based Cohort Study of Older Chinese People. FRONT MED-LAUSANNE. 2018;5:50.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSugimoto T, Sakurai T, Ono R, Kimura A, Saji N, Niida S, Toba K, Chen L, Arai H. Epidemiological and clinical significance of cognitive frailty: A mini review. AGEING RES REV. 2018;44:1\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAprahamian I, Suemoto CK, Aliberti MJR, de Queiroz Fortes Filho S, de Ara\u0026uacute;jo Melo J, Lin SM, Filho WJ. Frailty and cognitive status evaluation can better predict mortality in older adults? ARCH GERONTOL GERIAT. 2018;77:51\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFabr\u0026iacute;cio DDM, Chagas MHN, Diniz BS. Frailty and cognitive decline. Translational research: J Lab Clin Med. 2020;221:58\u0026ndash;64.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, Seeman T, Tracy R, Kop WJ, Burke G, et al. 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Frailty is Associated With Increased Complication, Readmission, and Hospitalization Costs Following Primary Total Knee Arthroplasty. J Arthroplast. 2023;38(7 Suppl 2):S182\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGuo K, Wang X, Lu X, Yang Y, Lu W, Wang S, Tang X, Wu Y, Xu Y, Chen Q, et al. Effects of sarcopenia and frailty on postoperative recovery in elderly patients: A prospective cohort study. J cachexia sarcopenia muscle. 2023;14(6):2642\u0026ndash;52.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHung C, Liu K, Tsai C, Lai C, Hsu J, Hsu C, Hung Y, Chou W. 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J CLIN ANESTH. 2022;80:110883.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBrigola AG, Ottaviani AC, Alexandre TDS, Luchesi BM, Pavarini SCI. Cumulative effects of cognitive impairment and frailty on functional decline, falls and hospitalization: A four-year follow-up study with older adults. ARCH GERONTOL GERIAT. 2020;87:104005.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChen C, Park J, Wu C, Xue Q, Agogo G, Han L, Hoogendijk EO, Liu Z, Wu Z. Cognitive frailty in relation to adverse health outcomes independent of multimorbidity: results from the China health and retirement longitudinal study. Aging. 2020;12(22):23129\u0026ndash;45.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHung C, Liu K, Tsai C, Lai C, Hsu J, Hsu C, Hung Y, Chou W. Impact of preoperative frailty on the surgical and survival outcomes in older patients with solid cancer after elective abdominal surgery. J Formos Med Association = Taiwan yi zhi. 2024;123(2):257\u0026ndash;66.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMakary MA, Segev DL, Pronovost PJ, Syin D, Bandeen-Roche K, Patel P, Takenaga R, Devgan L, Holzmueller CG, Tian J, et al. Frailty as a predictor of surgical outcomes in older patients. J AM COLL Surg. 2010;210(6):901\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBu Z, Huang A, Xue M, Li Q, Bai Y, Xu G. Cognitive frailty as a predictor of adverse outcomes among older adults: A systematic review and meta-analysis. BRAIN BEHAV. 2021;11(1):e1926.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhang XM, Wu XJ, Cao J, Jiao J, Chen W. Association between Cognitive Frailty and Adverse Outcomes among Older Adults: A Meta-Analysis. J Nutr Health Aging. 2022;26(9):817\u0026ndash;25.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang W, Si H, Yu R, Qiao X, Jin Y, Ji L, Liu Q, Bian Y, Yu J, Wang C. Effects of reversible cognitive frailty on disability, quality of life, depression, and hospitalization: a prospective cohort study. AGING MENT HEALTH. 2022;26(10):2031\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGale CR, Cooper C. Attitudes to Ageing and Change in Frailty Status: The English Longitudinal Study of Ageing. \u003cem\u003eGERONTOLOGY\u003c/em\u003e 2018, 64(1):58\u0026ndash;66.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-geriatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bgtc","sideBox":"Learn more about [BMC Geriatrics](http://bmcgeriatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bgtc/default.aspx","title":"BMC Geriatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Cognitive frailty, The elderly, Operation, Complication","lastPublishedDoi":"10.21203/rs.3.rs-4176242/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4176242/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eCognitive frailty is defined as the coexistence of physical frailty and mild cognitive impairment, which is associated with adverse outcomes. Due to various factors such as age-related changes in the brain and the presence of comorbidities, the elderly are more susceptible to cognitive frailty.\u003c/p\u003e\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003eTo investigate the effect of preoperative cognitive frailty on postoperative complications in elderly patients.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis prospective observational study was conducted among 253 patients aged 60\u0026ndash;85 years, who underwent elective orthopedic and abdominal surgery (postoperative hospital stay\u0026thinsp;\u0026ge;\u0026thinsp;3 days ) in the Second Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine from May 2023 to November 2023. Cognitive frailty was assessed using the MoCA for the cognitive status and the Fried criteria for five frailty scales. The participants were split into the following groups: group A, neither frail nor cognitive impairment; group B, only frailty ; group C, only cognitive impairment; group D, cognitive frailty. Primary outcome was the impact on postoperative complications. Secondary outcomes included mobility disability, prolonged hospital stay, re-operation and 90-day readmission.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe median age ( interquartile range ) of participants was 69 (65\u0026ndash;73) years, of which 40.3% were male. The prevalence of cognitive frailty was 17.8%. The incidence of postoperative complications was 18.2% in group A, 50.0% in group B, 37.4% in group C, and 75.6% in group D. The difference was significant (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). In the multivariate analysis, cognitive frailty [odds ratio (OR), 16.84; 95% confidence interval (CI), 4.54\u0026ndash;62.37], only frailty (OR, 7.86; 95%CI, 2.12-29. 12), only cognitive impairment (OR, 4.22; 95%CI, 1.62\u0026ndash;11.02).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eCognitive frailty was associated with higher risks of postoperative complications in elderly patients undergoing general anesthesia. It indicates that clinicians should pay much attention to these elderly with cognitive frailty.\u003c/p\u003e","manuscriptTitle":"Association of preoperative cognitive frailty with postoperative complications in elderly patients under general anesthesia: a prospective cohort study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-04-09 13:15:45","doi":"10.21203/rs.3.rs-4176242/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-09-13T06:28:25+00:00","index":"","fulltext":""},{"type":"reviewerAgreed","content":"10891022615115644920177956388679356401","date":"2024-09-13T00:17:20+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-09-12T19:16:34+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"54565841498381331048389872652839277838","date":"2024-09-12T18:36:27+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"107502802693774355277762450656711792225","date":"2024-09-12T18:34:04+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-09-12T03:50:24+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"109983473278828338345681262246550925833","date":"2024-09-10T00:31:06+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"73124954925042790947527484185313288413","date":"2024-09-09T22:01:17+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-08-31T17:17:43+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"133574474318930617296351784737053087582","date":"2024-08-26T12:29:10+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"29250053996692918103065277744884489587","date":"2024-06-08T05:45:03+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-05-16T06:14:51+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-05-16T06:11:55+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2024-04-04T08:57:47+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-04-04T08:52:15+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Geriatrics","date":"2024-03-27T12:57:12+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-geriatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bgtc","sideBox":"Learn more about [BMC Geriatrics](http://bmcgeriatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bgtc/default.aspx","title":"BMC Geriatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"6e6894c8-b378-4851-ae7c-ce43871fa6fa","owner":[],"postedDate":"April 9th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-10-21T16:07:34+00:00","versionOfRecord":{"articleIdentity":"rs-4176242","link":"https://doi.org/10.1186/s12877-024-05431-1","journal":{"identity":"bmc-geriatrics","isVorOnly":false,"title":"BMC Geriatrics"},"publishedOn":"2024-10-19 15:57:36","publishedOnDateReadable":"October 19th, 2024"},"versionCreatedAt":"2024-04-09 13:15:45","video":"","vorDoi":"10.1186/s12877-024-05431-1","vorDoiUrl":"https://doi.org/10.1186/s12877-024-05431-1","workflowStages":[]},"version":"v1","identity":"rs-4176242","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4176242","identity":"rs-4176242","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}