Postoperative cognitive dysfunction in older surgical patients associated with increased healthcare utilization: a prospective study from an upper-middle-income country

Abstract

Background Perioperative neurocognitive disorder includes postoperative cognitive dysfunction (POCD) and postoperative delirium (POD). Concerning inconclusive consequences of POCD compared with POD, we explored the association between either POCD or POD and functional decline as well as healthcare utilization. Methods Patients aged at least 60 years who underwent a major operation were enrolled. POCD was defined as a decrease in the Montreal Cognitive Assessment (MoCA) score (≥ 2) 1 week after surgery. Postoperative delirium (POD) was defined according to the criteria of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The primary outcome was instrumental activities of daily living (IADLs) 3 months after discharge. Secondary outcomes were the length of stay (LOS), hospital cost, and factors that affected functional decline 3 months after surgery. The multivariate model, including potential confounding factors, namely age, gender, surgery type, and postoperative complications, was used to analyze possible factors that influenced a reduction in function, and the results were expressed by using adjusted relative risk (RR) and 95%CI. Results Two hundred eighty-nine patients with a mean age of 72 years were enrolled. The incidence of POCD at 1 week was 28.5%. At their 3-month follow-ups, the patients with POCD were not associated with IADL decline. Nevertheless, patients with POCD were more likely to need a prolonged LOS (11 days [1, 46] vs. 8 days [2, 42]; P = 0.01), and incur higher hospital costs (8973.43 USD [3481.69, 11 763.74] vs. 5913.62 USD [332.43, 19 567.33]; P < 0.001). Additionally, the patients experiencing POD demonstrated increased risks of reducing their IADLs (adjusted RR 2.33; 95% CI, 1.15–4.71; P = 0.02). Conclusions POCD at 1 week leaded to increase healthcare utilization in a middle-income country. POD during hospitalization was associated with a decline in function after surgery and increased health care utilization. Trial registration Thai Clinical Trials Registry TCTR20190115001.

Effects of regional cerebral oxygen saturation monitoring on postoperative cognitive dysfunction in older patients: a systematic review and meta-analysis

“…In the present meta-analysis, we found that the LOS of older non-cardiac surgical patients who did not receive intraoperative rSO 2 monitoring was significantly prolonged and was accompanied by an increased incidence of POCD. A recently published prospective study revealed that older surgical patients with POCD are prone to need a prolonged LOS, which suggests the potential consequence of POCD, although clinically subtle, has a noticeable adverse impact on healthcare system expenditure [ 10 ]. Therefore, we should actively apply appropriate strategies, such as intraoperative rSO 2 monitoring, to prevent the occurrence of POCD in a high-risk population.…”

“…Previous studies have revealed that the incidence of POCD in older individuals varies from 16.7 to 89% one week after surgery [6][7][8][9]. It is well established that POCD is associated with a range of negative outcomes, including prolonged hospitalization, changes in mood and personality, reduced quality of life, heavy burden on the family and society, and increased mortality [10,11].…”

Study on the Effect of Dexmedetomidine on Postoperative Cognitive Dysfunction and Inflammation in Aged Rats

“…Many studies showed that the reductions of neuron number, cognitive related neurotransmitters, and corresponding receptors could cause the decline of cognitive function [ 10 , 11 ]. Other studies showed that surgical trauma was one of the high risk factors for the cognitive dysfunction [ 12 ]. This was because that surgical trauma could cause the release of inflammatory cytokines, which played an important role in the development of cognitive dysfunction [ 13 ].…”

Year in Review 2021: Noteworthy Literature in Cardiothoracic Anesthesia

“…38,39 These changes, formerly referred to as postoperative cognitive decline (POCD) and now as postoperative neurocognitive disorder (PNCD), are associated with depression, functional decline, longer hospital stays, long-term care admissions, and billions of dollars in healthcare costs. 40 As the population ages, demand for cardiac surgery is anticipated to rise and the number of patients at risk for PNCD will increase in parallel. Risk factors associated with PNCD have been identified, including age, preoperative conditions including dementia, cognitive impairment, depression, and stroke, and postoperative events including new arrythmias and longer intensive care unit (ICU) stays.…”