Investigating Perioperative Outcomes after Surgical Events: IMPOSE

Prior to surgery patients who consent for this study will undergo a cognitive screen in the pre-admission clinic prior to surgery. This assessment will include the modified telephone cognitive screen (TICS-M), 3D CAM, Richmond Agitation and Sedation Scale, Pain scale and the Healthy Brain Aging clinic questionnaire. Additionally the anaesthetic doctor will collect a blood sample prior to incision on the day of surgery. This sample will be sent to pathology for measurement of inflammatory markers (WCC, Troponin and CRP), and some plasma will be aliquoted and stored in the labaratory for biomarker analysis. Patients will be observed and assessed on postoperative days 1-4 in both the morning and evening. During these assessments they will complete the 3D Cam and have some blood collected to be measured for the same tests as per the pre-operative bloods. If a patient scores positively for delirium at any point during the postoperative days 1-4, they will be offered referral to the Healthy Brain Aging Clinic at the University of Sydney and provided a referral letter by the Principal Investigator on discharge. The patient will be provided information about the Healthy Brain Aging Clinic along with the referral and will be made aware that it will be their responsibility to contact the clinic to arrange an appointment. The PI/research team will not be invovled in their ongoing relationship with the HBA. Currently patients who score positively for delirirum postoperatively will be monitored and treated as necesary by their medical team, however a referral to the HBA is not standard practice. Outside of this study, if a patient required ongoing care for delirium, it would occur through their GP who would be alerted to issues with cognitive function/delirium during their inpatient stay. At one-year post-surgery the patient will be called and asked to complete the TICS-M again (on the phone) as well as the HBA questionnaire. Additionally if referred to the HBA during their stay in hospital the research team will collect data on their interaction with the clinic.