Trail making test B in postoperative delirium: a replication study

Marinus Fislage; Insa Feinkohl; Friedrich Borchers; Maria Heinrich; Tobias Pischon; Dieuwke S Veldhuijzen; Arjen J C Slooter; Claudia D Spies; Georg Winterer; Norman Zacharias; BioCog Consortium

doi:10.1016/j.bjao.2023.100239

Trail making test B in postoperative delirium: a replication study

BJA Open. 2023 Nov 3:8:100239. doi: 10.1016/j.bjao.2023.100239. eCollection 2023 Dec.

Authors

Marinus Fislage^{1

2}, Insa Feinkohl^{3

4}, Friedrich Borchers¹, Maria Heinrich^{1

5}, Tobias Pischon^{4

6

7}, Dieuwke S Veldhuijzen^{8

9}, Arjen J C Slooter^{10

11

12

13}, Claudia D Spies¹, Georg Winterer^{1

14}, Norman Zacharias^{1

14}; BioCog Consortium

Affiliations

¹ Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Berlin, Germany.
² Department of Neurology, National Taiwan University Hospital, Taipei, China.
³ Witten/Herdecke University, Faculty of Health/School of Medicine, Witten, Germany.
⁴ Max-Delbrueck-Center for Molecular Medicine in the Helmholtz Association (MDC), Molecular Epidemiology Research Group, Berlin, Germany.
⁵ Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany.
⁶ Max-Delbrueck-Center for Molecular Medicine in the Helmholtz Association (MDC), Biobank Technology Platform, Berlin, Germany.
⁷ Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Core Facility Biobank, Berlin, Germany.
⁸ Health, Medical and Neuropsychology Unit, Leiden University, Leiden, the Netherlands.
⁹ Leiden Institute for Brain and Cognition, Leiden, the Netherlands.
¹⁰ Department of Psychiatry, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
¹¹ Department of Intensive Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
¹² UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
¹³ Department of Neurology, UZ Brussel and Vrije Universiteit Brussel, Brussels, Belgium.
¹⁴ Pharmaimage Biomarker Solutions GmbH, Berlin, Germany.

Abstract

Background: The Trail Making Test B (TMT-B) is indicative of cognitive flexibility and several other cognitive domains. Previous studies suggest that it might be associated with the risk of developing postoperative delirium, but evidence is limited and conflicting. We therefore aimed to replicate the association of preoperative TMT-B results with postoperative delirium.

Methods: We included older adults (≥65 yr) scheduled for major surgery and without signs of dementia to participate in this binational two-centre longitudinal observational cohort study. Presurgical TMT-B scores were obtained. Delirium was assessed twice daily using validated instruments. Logistic regression was applied and the area under the receiver operating characteristic curve calculated to determine the predictive performance of TMT-B. We subsequently included covariates used in previous studies for consecutive sensitivity analyses. We further analysed the impact of outliers, missing or impaired data.

Results: Data from 841 patients were included and of those, 151 (18%) developed postoperative delirium. TMT-B scores were statistically significantly associated with the incidence of postoperative delirium {odds ratio per 10-s increment 1.06 (95% confidence interval [CI] 1.02-1.09), P=0.001}. The area under the receiver operating characteristic curve was 0.60 ([95% CI 0.55-0.64], P<0.001). The association persisted after removing 21 outliers (1.07 [95% CI 1.03-1.07], P<0.001). Impaired or missing TMT-B data (n=88) were also associated with postoperative delirium (odds ratio 2.74 [95% CI 1.71-4.35], P<0.001).

Conclusions: The TMT-B was associated with postoperative delirium, but its predictive performance as a stand-alone test was low. The TMT-B alone is not suitable to predict delirium in a clinical setting.

Clinical trial registration: NCT02265263. (https://clinicaltrials.gov/ct2/show/results/NCT02265263).

Keywords: Geriatric anaesthesia; Open science; Perioperative medicine; Postoperative delirium; Replication; Risk prediction; Trail making test.

Associated data

ClinicalTrials.gov/NCT02265263