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Evaluation of the Cognitive Performance of Hypertensive Patients with Silent Cerebrovascular Lesions
Published on: April 23, 2021
Association between cerebrovascular disease and perioperative neurocognitive disorders: a retrospective cohort study
Lan Feng1,2,3, Yuanhui Liu1,2, PengFei Li1,2
1Department of Anesthesiology.
Insights
Preoperative cerebrovascular disease (CVD) significantly increases the risk of perioperative neurocognitive disorders (PNDs) and negatively impacts postoperative survival in surgical patients. This study highlights CVD as a critical factor in surgical outcomes.
Area of Science:
- Neurosurgery
- Vascular Neurology
- Anesthesiology
Background:
- Cerebrovascular disease (CVD) is linked to cognitive decline.
- The impact of preoperative CVD on perioperative neurocognitive disorders (PNDs) is not well understood.
- This study investigates the association between preoperative CVD and PNDs.
Purpose of the Study:
- To explore the correlation between preoperative cerebrovascular disease (CVD) and perioperative neurocognitive disorders (PNDs).
- To develop a clinical prediction model for PNDs using logistic regression and ROC curves.
- To analyze the effect of preoperative CVD on postoperative survival rates.
Main Methods:
- Retrospective cohort study of 13,899 surgical patients.
- Comparison of PND incidence between CVD and non-CVD groups.
- Multivariate logistic regression and ROC curve analysis for PND prediction.
- Cox proportional hazard regression for survival analysis.
Main Results:
- Cerebrovascular disease (CVD) is an independent risk factor for PNDs (OR: 10.193, P <0.001).
- A clinical prediction model for PNDs demonstrated good performance (AUC: 0.798).
- CVD significantly affected the overall postoperative survival rate (HR: 1.398, P <0.001).
Conclusions:
- Preoperative cerebrovascular disease (CVD) is a significant independent risk factor for perioperative neurocognitive disorders (PNDs).
- CVD negatively impacts the overall postoperative survival rate in surgical patients.
- The findings underscore the importance of considering preoperative CVD in surgical risk assessment.
Background:
Previous studies have shown that patients with cerebrovascular disease (CVD) have a significantly increased risk of cognitive decline or dementia; however, the association between preoperative CVD and perioperative neurocognitive disorders (PNDs) remains unclear. This study aimed to explore the correlation between preoperative CVD and PNDs, as well as combine logistic regression and receiver operating characteristic (ROC) curves to construct a clinical prediction PND model.
Materials And Methods:
This retrospective cohort study evaluated 13 899 surgical patients of a large-scale comprehensive hospital between January 2021 and January 2022 to explore the association between preoperative CVD and PNDs, with follow-up to monitor postoperative survival until 28 February 2023, unless the patient died. The study participants comprised all inpatients from the Bone and Joint Surgery, Spine Surgery, Urology, Hepatobiliary Surgery, Gastrointestinal Surgery, and Thoracic Surgery departments. Patients were classified into two groups: the CVD group with a confirmed diagnosis and the noncerebrovascular disease group. The incidence of PNDs was measured, and potential associations between patient demographic information, preoperative comorbidities, and CVD, as well as the correlation between preoperative CVD and PNDs, were investigated by multivariate logistic regression analysis. Next, the authors constructed a clinical prediction PND model by drawing the ROC curve. The postoperative survival of all patients was tracked, and a survival curve was constructed and incorporated into the Cox proportional hazard regression model to analyze the relationship between preoperative CVD and the overall postoperative survival rate.
Results:
Of the included 13 899 patients, propensity score matching yielded 1006 patient pairs. Multivariate logistic regression analysis revealed that CVD was an independent risk factor for PNDs [odds ratio: 10.193; 95% CI: 7.454-13.938; P <0.001]. Subsequently, the authors developed a clinical prediction model for PNDs by multivariate logistic regression analysis. The area under the ROC curve was 0.798 (95% CI: 0.765-0.830). The survival of 11 702 patients was followed up. Multivariate Cox hazard ratio regression analysis revealed that CVD affected the overall postoperative survival rate (hazard ratio, 1.398; 95% CI: 1.112-1.758; P <0.001).
Conclusion:
CVD was an independent risk factor for PNDs and affected the overall postoperative survival rate of surgical patients with preoperative CVD.
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