Surgical apgar score and delayed neurocognitive recovery in elderly patients: a prospective cohort study

Delayed neurocognitive recovery (dNCR) is a prevalent postoperative complication in elderly patients. Currently, there is no effective treatment for it. Consequently, timely risk identification and prevention of it are crucial.

The aim of our study is to provide a clinical tool for the prediction of dNCR by exploring the relationship between the surgical Apgar score (SAS) and dNCR in elderly patients and investigating its predictive value.

The elderly patients undergoing general anesthesia at Southwest Medical University Hospital from January 2024 to May 2025 were included in this study. Cognitive function was tested by the MoCA scale before surgery, postoperative day 7 and postoperative day 30. The dNCR and non-dNCR groups were classified according to whether dNCR occurred after surgery. SAS were calculated as the lowest mean arterial pressure (LMAP), lowest heart rate (LHR) and blood loss. The relationship between dNCR and SAS was analyzed, we drew the receiver operating characteristic (ROC) curve of SAS-predicted dNCR, and calculated the area under the curve, the optimal cut-off, sensitivity and specificity.

The incidence of dNCR was 23.86%, including 15.7% at 7 days, 19.6% at 30 days, and 14.7% had dNCR both at 7 and 30 days after surgery. Logistic regression analysis showed SAS (OR = 6.326, P = 0.001), Pittsburgh Sleep Index (OR = 3.834, P < 0.001), frailty (OR = 3.388, P = 0.027) and anxiety (OR = 3.520, P = 0.002) were risk factors for dNCR. The AUC value of dNCR ROC curve was 0.876 (95% CI: 0.794-0.948, P < 0.001). When taking 8 as the optimal cut-off, the sensitivity is 0.630 and the specificity is 0.893.

This study demonstrated that low SAS is a risk factor for dNCR; and SAS score < 8 is classified as high-risk population. It provides a simple and objective prediction tool for dNCR, not only enabling medical staff to identify patients at risk and take early interventions, but also to support their goal-directed management decisions for the intraoperative circulatory system. Furthermore, we also found that sleep, frailty and anxiety are also influencing factors of dNCR.

China Clinical Experiment Center (ChiCTR2300078388), December 7, 2023.