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Predictors and occurrence of postoperative cognitive dysfunction in children undergoing noncardiac surgery: A
Fang-Fang Han1,2, Xiu-Mei Wang2, Hai-Jun Zhang1,2
1The First Clinical Medical College of Lanzhou University Lanzhou Gansu P.R. China.
Insights
Postoperative cognitive dysfunction (POCD) affects 15.6% of children after noncardiac surgery. Key risk factors include prior surgery, longer anesthesia times, and early postoperative fever, highlighting the need for vigilance in pediatric surgical care.
Area of Science:
- Pediatric Anesthesiology
- Neuroscience
- Surgical Outcomes
Background:
- Postoperative cognitive dysfunction (POCD) is recognized in children following cardiac surgery.
- The incidence and risk factors for POCD in children undergoing noncardiac surgery remain largely unknown.
Purpose of the Study:
- To determine the incidence rate of early neurocognitive dysfunction in children after noncardiac surgery.
- To identify potential risk factors associated with the development of POCD in this pediatric population.
Main Methods:
- A prospective observational study involving 200 children (4-14 years) undergoing elective noncardiac surgery and 100 age-matched controls.
- Neurocognitive assessments using Wechsler scales were performed preoperatively and 3 days postoperatively.
- Multivariate logistic regression analysis identified independent risk factors for POCD.
Main Results:
- The overall incidence of early POCD was 15.6%.
- Independent risk factors identified for POCD included a history of surgery, longer anesthesia duration, and early postoperative fever (EPF).
Conclusions:
- Early postoperative cognitive dysfunction occurs in 15.6% of children following noncardiac surgery.
- Children with a history of surgery, prolonged anesthesia, or EPF are at increased risk for developing POCD.
Abstract:
In children after cardiac surgery, alterations in cognitive ability and behavior are increasingly common, but whether postoperative cognitive dysfunction (POCD) occurs in children undergoing noncardiac surgery is not known. The present study was performed to investigate the incidence rate and potential risk factors of early neurocognitive dysfunction in children after noncardiac surgery. Two hundred patients aged between 4 and 14 years old underwent elective noncardiac surgery and 100 healthy age-matched controls were enrolled in this prospective observational study. Wechsler Preschool and Primary Scale of Intelligence or Wechsler Intelligence Scale for Children-Revised were conducted 1 day before and 3 days after surgery. POCD was calculated and diagnosed as a combined Z score. Any factors that differed between POCD and non-POCD group (p < 0.10) were tested together by multivariate logistic regression analysis against the cognitive outcome of patients, to find out the independent risk factors of POCD. The general incidence of POCD was 15.6%. The univariate analysis revealed that POCD was associated with general anesthesia, surgical and anesthesia duration, early postoperative fever (EPF), and surgical history. However, only the history of surgery (p = 0.029), anesthesia duration (p = 0.010), and EPF (p < 0.001) were demonstrated to be independent risk factors for POCD. The occurrence rate of early POCD after noncardiac surgery in children is 15.6%. Children who had surgical history, longer anesthesia duration, or EPF are more prone to develop POCD.
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