BackgroundThe relationship between early childhood exposure to general anesthesia (GA) and the risk of developing Attention Deficit Hyperactivity Disorder (ADHD) is still uncertain and previous studies have presented conflicting results. This population‐based cohort study aimed to investigate the potential relationship between GA exposure and ADHD risk using propensity score matching (PSM) in a large sample size.MethodsThe study included 15,072 children aged 0–3 years who received GA and were hospitalized for more than 1 day in Taiwan from 2004 to 2014. The nonexposed group was randomly selected through 1:1 PSM from the Taiwan Maternal and Child Health Database (TMCHD). The primary objectives of this study were to determine the incidence rates (IR) and incidence rate ratios (IRR) of ADHD in the two cohorts, employing Poisson regression models.ResultsThe GA group and non‐GA group each comprised 7,536 patients. The IR of ADHD was higher in the GA group (122.45 per 10,000 person‐years) than in the non‐GA group (64.15 per 10,000 person‐years), and the IRR of ADHD in the GA group was 1.39 (95% CI: 1.26, 1.55). The study found that the number of times of exposure to GA, duration of exposure, male gender, and central nervous system surgery were significant risk factors for ADHD in the future.ConclusionsThis study's findings suggest that there is a significant correlation between early childhood exposure to GA and the risk of developing ADHD, and GA may be an important risk factor for ADHD in children undergoing surgery. The study also identified several risk factors for ADHD, including the number of times of exposure to GA, duration of exposure, male gender, and central nervous system surgery.
BackgroundPreoperative cognitive impairment (PCI) may increase the incidence of postoperative delirium (POD), yet screening for cognitive impairment is rarely performed. This study hypothesized that Mini-Cog for preoperative cognitive impairment screening predicts postoperative delirium.MethodsThe prospective observational study recruited 153 elderly patients presenting for elective thoracic surgery. Cognitive function of these patients was screened using Mini-Cog preoperatively. We considered that patients with Mini-Cog scores ≤ 3 had cognitive impairment. Delirium was assessed using the Short CAM scale on postoperative days 1–5.ResultsOf the 153 participants, 54 (35.3%) were assigned to the PCI group, and 99 (64.7%) were assigned to the Normal group. Place of residence, education level, and history of hypertension were significantly different between the two groups (P < 0.05). 51 (33.3%) patients developed POD. Multifactorial analysis revealed that PCI (OR = 2.37, P = 0.028), older age (OR = 1.13, P = 0.009), ASA grade III (OR = 2.75, P = 0.012), and longer duration of anesthesia (OR = 1.01, P = 0.007) were associated with POD.ConclusionPreoperative cognitive impairment is strongly associated with POD. Mini-Cog could be recommended for screening PCI.Clinical trial registrationClinicalTrials.gov, identifier NCT05798767.
Aims: The study aims to investigate the impact of statin use on sepsis mortality in patients with type 2 diabetes (T2DM) in a dose-, class-, and use intensity-dependent manner. Methods: A retrospective cohort of 850,326 T2DM patients was analyzed using an inverse probability treatment-weighted Cox hazard model, with statin use status as a time-dependent variable. Results: Results showed that statin use was associated with a significant reduction in sepsis mortality risk (aHR=0.29) compared to non-users. Pitavastatin, rosuvastatin, pravastatin, atorvastatin, simvastatin, fluvastatin, and lovastatin were all associated with a lower sepsis mortality risk. Higher cumulative defined daily dose per year of statins was also associated with a lower sepsis mortality, with an optimal daily dose of 0.86 defined daily doses. Conclusion: These findings suggest that statin use may reduce sepsis mortality in T2DM patients and that higher doses are associated with greater protection.
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