History of alcohol abuse after major non-cardiac surgery and postoperative cognitive dysfunction

The risk factors for postoperative cognitive dysfunction (POCD) after non-cardiac surgery include advanced age and preexisting cognitive impairment.

Data was collected in a prospective manner on 220 patients of both genders. Patients were triaged into three groups, with American Society of Anesthesiologists-ASA Physical Classification System levels I-IV. Patients were 55 years of age and older, with self-reported alcohol abuse and were matched to age-, sex-, and education-matched nonalcoholic controls. They were tested using a neurocognitive battery before and two weeks after elective surgery or after a corresponding time interval without surgery. Verbal memory, visuospatial memory, and executive functions were assessed. Neurologic examination was performed in order to exclude subjects with potential cerebrovascular damage. Standard laboratory analyses were done and findings recorded. Significant predisposing factors for developing POCD were noted.

From the total number of participants involved in the study, 135 (67.5%) patients belonged to ASA class III. Among all patients, 168 (84%) patients were chronic alcohol users. Pearson's χ(2) test shows a statistically significant difference regarding the use of alcohol (χ(2)=19.220, df=1, p=0.000, p<0.05). Significant three-way interactions (analysis of variance) for Visual Immediate Recall, Visual Delayed Recall, Semantic Fluency, Phonemic Fluency, and the Color-Word Stroop Test implied that cognitive performance in the alcoholic group decreased after surgery.

In the study by Mason which involved 255 elderly patients that were postoperatively admitted to the intensive care unit following a major abdominal surgery, development of POCD was two times greater in urgent cases (~40% of cases), when compared to elective interventions.

Our results complement the data given by the World Health Organization and results of similar studies.