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Risk Factors for Postoperative Cognitive Decline After Orthopedic Surgery in Elderly Chinese Patients: A
Xian Li1, Hong Lai2, Peng Wang3
1Department of Neurology & Neurobiology, Xuanwu Hospital, Capital Medical University, National Clinical Research Center for Geriatric Diseases, Beijing, 100053, People's Republic of China.
Clinical Interventions in Aging
|March 25, 2024
Summary
Postoperative cognitive decline (POCD) is common in older adults after orthopedic surgery, particularly affecting calculation, recall, and attention. Comprehensive geriatric assessments pre-surgery help identify patients at high risk for POCD.
Area of Science:
- Geriatric Medicine
- Anesthesiology
- Neuroscience
Background:
- Postoperative cognitive decline (POCD) is a significant concern in elderly patients undergoing surgery.
- Preoperative comprehensive geriatric assessment (CGA) and intraoperative anesthetic management are potential factors influencing POCD.
Purpose of the Study:
- To identify risk factors for POCD in older adults undergoing elective orthopedic surgery.
- To evaluate the role of preoperative CGA and intraoperative anesthetic interventions in POCD development.
Main Methods:
- Data from the Aged Patient Perioperative Longitudinal Evaluation-Multidisciplinary Trial (APPLE-MDT) cohort (March 2019-June 2022) were analyzed.
- 119 elderly patients underwent preoperative CGA and cognitive function assessment using the Montreal Cognitive Assessment scale.
- POCD was defined as a drop of ≥1 point between preoperative and postoperative cognitive scores.
Main Results:
- POCD occurred in 35.3% of patients, with significant declines in calculation, recall, and attention.
- Multivariable analysis identified postoperative respiratory failure (PRF) ≥4.2% as a risk factor (OR=2.343) and Sufentanil for anesthesia maintenance as a protective factor (OR=0.260).
Conclusions:
- POCD is prevalent in elderly patients after orthopedic surgery, predominantly impacting calculation, recall, and attention.
- Preoperative comprehensive geriatric assessments are crucial for identifying individuals at high risk of POCD.
