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Updated: Apr 19, 2026
A Mouse Model of Orthopedic Surgery to Study Postoperative Cognitive Dysfunction and Tissue Regeneration
Published on: February 27, 2018
Toward precision risk stratification of postoperative cognitive dysfunction: Preoperative inflammatory and
Abdulrahman Khaled Alwesabi1, Boxiong Gao2, Yuhu Ma3
1The First School of Clinical Medicine, Lanzhou University, Lanzhou, Gansu, China; Department of Anesthesiology, Faculty of Medicine and Health Sciences, Al-Razi University, Sana'a, Yemen.
Background:
Postoperative Cognitive Dysfunction (POCD) is a common complication in older adults undergoing major surgery and is associated with prolonged recovery and long-term cognitive decline. Identification of reliable preoperative protein biomarkers may enable early risk stratification and personalized perioperative management.
Methods:
We conducted a systematic review of prospective cohort studies evaluating preoperative inflammatory and neurodegenerative protein biomarkers and subsequent POCD. PubMed, Embase, Web of Science, Cochrane CENTRAL, and Scopus were searched from inception to October 30, 2025. Eligible studies measured protein biomarkers in blood or cerebrospinal fluid (CSF) before surgery and reported structured postoperative cognitive outcomes. Risk of bias was assessed using the Newcastle-Ottawa Scale. Due to heterogeneity in biomarkers, assays, and POCD definitions, findings were synthesized narratively.
Results:
Six prospective cohort studies involving 705 patients undergoing major orthopedic surgery were included. Biomarkers evaluated comprised inflammatory cytokines (IL-1β, IL-6, TNF-α, IL-8, CRP), neuronal and glial injury markers (S100B, NSE, GFAP, NFL), and Alzheimer-related CSF proteins (Aβ₁₋₄₂, Aβ₄₀, total tau, phosphorylated tau). Lower preoperative CSF Aβ₁₋₄₂ levels and reduced Aβ/tau ratios were the most consistent predictors of POCD. Single serum biomarkers, including S100B and inflammatory cytokines, demonstrated variable or limited predictive value. Composite inflammatory profiles showed potential for identifying patients at risk of long-term cognitive decline.
Conclusions:
Preoperative CSF amyloid-related biomarkers demonstrated relatively stronger associations with POCD in the available studies; however, evidence remains limited and further validation is required, while multi-marker inflammatory signatures may enhance risk assessment. Standardized studies are required to support clinical implementation.
