Incidence and risk factors for postoperative cognitive dysfunction in older adults undergoing major noncardiac surgery: A prospective study

Abstract

Background & Aims:Postoperative cognitive dysfunction (POCD) is a decline in cognitive function that occurs after surgery. The purpose of this study was to estimate the incidence and identify potential risk factors of POCD in older adults undergoing major noncardiac surgery.Materials and Methods:A total of 69 patients aged 65 years or older undergoing major noncardiac surgery were enrolled. Patients’ cognitive function was assessed before and 3 months after surgery using a computerized neurocognitive battery. A nonsurgical control group of 54 older adults was recruited to adjust for learning effects from repeated administration of neurocognitive tests. Data about potential risk factors for POCD were collected before, during, and after surgery, including patient, medication, and surgery factors. The incidence of POCD was calculated using the Z-score method. A multivariable logistic regression model was used to identify risk factors for POCD.Results:POCD was present in eleven patients (15.9%, 95% confidence interval [CI] = 7.3-24.6) 3 months after major noncardiac surgery. Carrying the apolipoprotein E4 (APOE4) genotype (odds ratio [OR] = 4.74, 95% CI = 1.09-22.19), using one or more highly anticholinergic or sedative-hypnotic drugs at home prior to surgery (OR = 5.64, 95% CI = 1.35-30.22), and receiving sevoflurane for anesthesia (OR = 6.43, 95% CI = 1.49-34.66) were associated with the development of POCD.Conclusions:POCD was observed in 15.9% of older adults after major noncardiac surgery. Risk factors for POCD in these patients were carrying the APOE4 genotype, using one or more highly anticholinergic or sedative-hypnotic drugs prior to surgery, and receiving sevoflurane for anesthesia.

Associations of dyslipidaemia and lipid-lowering treatment with risk of postoperative cognitive dysfunction: a systematic review and meta-analysis

“…Where reported, mean sample age ranged from 61 to 71 years (mean 67 years). All except one study19 had recruited more males than females. Surgical procedures included cardiac surgery (n=8) and non-cardiac surgery (n=8); one study included both 21…”

Effect of pre-emptive analgesia by continuous femoral nerve block on early postoperative cognitive function following total knee arthroplasty in elderly patients

“…Studies of POCD have been conducted at a later time postsurgery; however, to the best of our knowledge, not during the initial days following surgery (6,(10)(11)(12). Furthermore, to the best of our knowledge, no studies have yet investigated the effect of pre-emptively blocking pain transmission on acute POCD in the first days following surgery.…”

“…In tendon graft repair, the use of postoperative femoral nerve infusion of ropivacaine reduces early postoperative pain (2 h following surgery) more effectively when administered pre-emptively rather than when administered at the end of surgery (8). It has been demonstrated that femoral nerve infusion of ropivacaine improves pain control for one day after TKA treatment, compared with epidural ropivacaine infusion, which continues for 6 h (9).Studies of POCD have been conducted at a later time postsurgery; however, to the best of our knowledge, not during the initial days following surgery (6,(10)(11)(12). Furthermore, to the best of our knowledge, no studies have yet investigated the effect of pre-emptively blocking pain transmission on acute POCD in the first days following surgery.…”

Effects of the Transcranial Direct Current Stimulation on Prevention of Postoperative Cognitive Dysfunction after Cardiac Surgery: Prospective, Randomized, Double-Blind Study

“…It's considered a contrary event observed in elderly patients submitted to a cardiac surgery [1], being rare among youngster patients and others who submit to noncardiac surgeries [2]. Even though some researches show that local anesthesia can cause cognitive dysfunction, it is known that general anesthesia and its depth can lead to a higher percentage of POCD [3].…”