SAGES - Successful Aging after Elective Surgery
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The SAGES I Collection in the Aging Biobank consists of data and biospecimens from 306 of the original 560 SAGES I participants, all of whom consented to share their data and specimens with the broader biomedical research community. The characteristics of the 306 participants in the Biobank did not differ significantly from the overall SAGES I study in important characteristics, including delirium rate.
Only the included data are available for sharing at this time. Appropriate uses of the SAGES collection will take advantage of the unique resources provided by our cohort to advance the science of perioperative care of older adults. The resources include: 1) a well-characterized baseline in 306 older adults undergoing major surgery with measures of cognition, cognitive reserve, physical function, and medical morbidity, 2) type of elective surgery (major non-cardiac surgical procedure), 3) detailed measures of postoperative delirium, including ratings of delirium severity, 4) long term measures of cognition and physical function out to 18 months after surgery, 5) serial plasma samples collected pre- and post- surgery, and 6) preoperative DNA samples.
ObjectivesThe Successful Aging after Elective Surgery (SAGES) I study was performed to identify novel risk factors for delirium, including blood-based biomarkers and cognitive reserve markers, and to describe the long-term effects of delirium on cognitive and functional capacity in older adults following elective surgery. The study was funded by a Program Project grant (P01AG031720) from the National Institute on Aging, a component of the National Institutes of Health. The SAGES I study was completed during the first cycle of this Program Project grant.
BackgroundOlder adults commonly develop delirium after major surgical procedures, characterized by acute confusion and reduced awareness. From the literature, delirium has been associated with many adverse short-term outcomes including increased postoperative complications, prolonged hospital stay, increased need for post-discharge skilled nursing facility care, and increased perioperative mortality. Long term, delirium is associated with cognitive and functional decline, increased costs, and possibly incident dementia. SAGES’ overall aims were to examine the long-term effects of postoperative delirium on trajectories of physical and cognitive function in older patients, controlling for detailed baseline status, and to identify novel risk factors associated with delirium, which might shed light on its pathophysiology, enabling design and testing of targeted interventions.
Study DesignSAGES I was a five-year prospective cohort study that enrolled 560 patients, who were all recruited from two large hospitals in Boston, Massachusetts from 2010 to 2013, with follow-up to 2015. Participants were age 70 years and older, scheduled to undergo major elective surgery with an expected hospital stay of at least two days, and who did not have diagnosed or recognizable dementia. Individuals were excluded from enrollment if dementia, active delirium, or other cognitive impairment were present prior to surgery; other exclusions included hospitalization within three months of study enrollment, terminal illness, or a condition that might confound recognition of delirium (e.g., schizophrenia), or that might preclude completion of follow-up interviews (e.g., cancer requiring intensive chemotherapy).
Study participants underwent detailed in-home baseline assessments for physical and cognitive function prior to surgery. During their post-surgery hospital stay, patients were interviewed daily to assess for delirium using the long Confusion Assessment Method (CAM), which enables determination of delirium presence using the CAM algorithm, and measurement of delirium severity using the CAM-S long and short forms. Delirium presence was also ascertained by a validated chart review approach. After hospital discharge, participants completed telephone and in-home assessments to measure cognitive and physical function at predetermined intervals (1,2,6,12, and 18 months post-operatively) during follow-up, which ranged up to 18 months. Additionally, blood-based biomarkers were obtained from participants at four time points—baseline (preoperatively), in the post-anesthesia care unit, on the morning of postoperative day 2, and at one-month following surgery. Clinical data included health habits, hearing/vision impairment, comorbidity, and frailty at baseline. Finally, cognitive reserve markers, including personal educational history and reading level, were obtained.