The risk factors for cognitive dysfunction in elderly patients after laparoscopic surgery

Abstract

Postoperative cognitive dysfunction (POCD) is very common in clinical settings, it is necessary to analyze the risk factors for POCD in elderly patients after laparoscopic surgery to provide insights into clinical surgery management. Elderly patients undergone laparoscopy between September 1, 2018 and March 31, 2020 were included. The mini-mental state examination (MMSE) scale was used to evaluate the POCD, and the characteristics and clinical data of patients with and without POCD were collected and compared. Logistic regression was used to analyze the potential influencing factors. A total of 572 patients with laparoscopic surgery were included. The incidence of POCD was 11.89%. There were significant differences in the history of cerebral infarction, preemptive analgesia, preoperative use of dexmedetomidine, general anesthesia combined with continuous epidural block, duration of surgery, low SpO2 during anesthesia induction, PaCO2 after pneumoperitoneum, postoperative PCEA and VAS score at the third day after operation (all P < .05). Logistic regression analysis revealed that history of cerebral infarction (OR3.12, 1.02∼5.13), low SpO2 during anesthesia induction (OR2.03, 1.19∼4.47), Longer duration of surgery (OR1.82, 1.01∼3.16) were risk factors for POCD in elderly patients with laparoscopic surgery, while postoperative PCEA (OR0.43, 0.01∼0.91), General anesthesia combined with continuous epidural block (OR0.59, 0.04∼0.87), preoperative use of dexmedetomidine (OR0.70, 0.08∼0.94) and preemptive analgesia (OR0.75, 0.13–0.90) were the protective factors for POCD in elderly patients with laparoscopic surgery. For the elderly patients undergoing laparoscopic surgery, the health care providers should be fully alert to the POCD based on those relevant factors.

Early Cognitive Dysfunction in Elderly Patients after Total Knee Arthroplasty: An Analysis of Risk Factors and Cognitive Functional Levels

“…Prolonged surgery duration may lead to increased blood loss and inflammatory responses, as well as increased use of anesthetic drugs. As shown in numerous studies, the duration of the operation affects the occurrence of POCD [43]. However, no correlation between the time of operation and the occurrence of POCD was observed in our study.…”

Postoperative delirium and neurocognitive disorders

“…Polypharmacy can also contribute. Severe acute deteriorations including electrolyte disturbances, vitamin deficiencies such as severe hypovitaminosis D [42], hypotension, sleep deprivation, renal failure, liver failure, stroke, and acute trauma can precipitate delirium [3,43]. Long duration of surgery, transfusions, and cardiac surgery, especially with the use of cardiopulmonary bypass [44], are common surgical risk factors.…”

Effects of different levels of controlled hypotension on regional cerebral oxygen saturation and postoperative cognitive function in patients undergoing total knee arthroplasty

“…This may be related to the short duration of controlled hypotension and surgery in this study. Some studies also revealed that longer duration of surgery (OR1.82, 1.01∼3.16) were risk factors for POCD ( 19 ). A randomized trial shown that BIS decreases delayed neurocognitive recovery and postoperative neurocognitive disorder ( 20 ).…”