- Cognitive impairment is common in older surgical patients, affecting an estimated 37%–50% of this population.
- Despite its prevalence, cognitive impairment is frequently unrecognized and increases the risk of perioperative neurocognitive disorders and postoperative delirium (POD).
- Major professional organizations recommend preoperative cognitive assessment in older surgical patients, but previous studies demonstrate that routine cognitive screening remains uncommon in clinical practice.
- In this cross-section survey of participants in the Anesthesia Patient Safety Foundation (APSF) Patient Safety Priority Advisory Group and the broader APSF community, the authors evaluated current cognitive screening practices, perceived importance of cognitive screening, barriers to implementation, and educational needs.
- The survey was distributed to 205 APSF participants, with 113 responses (55% response rate). Among respondents with complete demographic data, 57.5% were physician anesthesiologists, and nearly two-thirds had more than 10 years of clinical experience.
- 65% of respondents rated preoperative cognitive screening as “very important” or “extremely important” for patient safety and outcomes. 28.75% rated it as “moderately important.”
- Despite the perceived importance of preoperative screening, only 3.8% routinely screened all surgical patients, and only 27.6% performed any screening at all, even in selected populations (e.g. older patients).
- The most frequently reported barriers to cognitive screening were lack of institutional support or formal protocols (48.5%), insufficient time during preoperative evaluation (39.4%), inadequate resources or staffing (37.9%), and lack of training on screening tools (30.3%).
- The survey demonstrates a substantial “knowledge-action gap” in perioperative brain health: anesthesia professionals recognize the importance of cognitive screening, but routine implementation remains extremely limited.
- The authors suggested that closing this implementation gap will require institutional support, standardized protocols, electronic health record integration, staff training, adequate resources, and clear clinical pathways for managing patients with positive cognitive screening results.
Summary of "Routine Preoperative Cognitive Assessment to Improve Brain Health in Older Surgical Patients: Insights From an Anesthesia Patient Safety Foundation Survey"
Summary published July 20, 2026
