Prediction and Prevention of Postoperative Mortality and Morbidity

Part I Inclusion Criteria: * 65 years of age and older * Identified as higher risk (≥2.5%) for 30-day mortality and MACCE based on the UPMC's Perioperative Model (EHR risk prediction algorithm) * Scheduled for major cardiac surgeries including coronary artery bypass and valvular repair and/or vascular surgeries including carotid endarterectomy, aortic aneurysm repair, and major vascular surgeries * RAI score ≥ 30 * Informed consent * English speaking patients Part II Inclusion Criteria: * Enrolled in Aim 1 / Part I Preoperative Intervention Trial * Scheduled for high-risk, cardiac or vascular surgery requiring intraoperative neurophysiological monitoring (IONM) * Moderate and high risk for mortality based on Society of Thoracic Surgery score (score \>4) Part I Exclusion Criteria: * Children (\<18 years) * Patients unable to provide consent * Participants undergoing same day procedures or operations (discharged same day) * Patients with severe preoperative medical diseases such as blindness or significant visual impairment, unresolved motor weakness, or any other perioperative events or complications that would have a bearing on the patient's ability to perform study tasks, neuropsychological tests, and proposed interventions Part II Exclusion Criteria: * Pregnant women * Patients do not provide consent. * Patients are unable to participate in cognitive and other behavioral assessment due to physical limitations * Patients refuse any blood transfusions during surgery