Which Predictor, SctO2 or SstO2, Is more Sensitive for Postoperative Cognitive Dysfunction in Spine Surgery: A...

Area of Science:

• Neurosurgery
• Anesthesiology
• Critical Care Medicine

Background:

• Prone spinal surgery can lead to venous stasis and edema, increasing the risk of postoperative cognitive dysfunction (POCD).
• POCD poses significant challenges to patient recovery, potentially causing permanent brain damage, increased mortality, and societal costs.
• Hypertension is a common comorbidity in patients undergoing spinal surgery, potentially exacerbating POCD risks.

Purpose of the Study:

• To determine the incidence of POCD in hypertensive patients following prone spine surgery.
• To investigate the association between intraoperative somatic tissue oxygen saturation (SstO2) and cerebral tissue oxygen saturation (SctO2) with POCD.

Main Methods:

• A prospective, observational study included 101 hypertensive patients undergoing open prone spine surgery.
• Near-infrared spectroscopy continuously monitored SctO2 and SstO2 throughout the surgical procedure.
• POCD was assessed using the Mini-Mental Status Examination (MMSE), with associations analyzed via logistic regression.

Main Results:

• The incidence of POCD was 27.8% (28 out of 101 patients).
• Decreased intraoperative SstO2 (absolute and relative) was significantly associated with POCD development.
• No significant association was found between SctO2 indices and POCD, nor between SctO2 and SstO2.

Conclusions:

• Intraoperative SstO2 monitoring may offer a valuable tool for predicting and potentially preventing POCD in hypertensive patients after prone spine surgery.
• SctO2 monitoring did not show an association with POCD in this patient cohort.
• Further research is warranted to explore SstO2-guided interventions for POCD prevention.