Cognitive Changes in Laparoscopic Cholecystectomy: Cognitive Assessments in Decision-Making Matters

Background: Cognitive changes after minor surgery may affect patient safety, functional recovery, and readiness for hospital discharge, even after low-risk procedures with early discharge protocols. In this regard, patients require neuropsychological assessment at discharge, which may have important clinical implications for return to daily activities and postoperative decision-making. Our study investigated postoperative cognitive changes after minor surgery under general anesthesia using a neuropsychological assessment and a non-surgical group. Methods: Patients undergoing laparoscopic cholecystectomy received propofol or sevoflurane anesthesia. A non-surgical control group was included. Cognitive performance was assessed at baseline and discharge using the Computerized Visual Attention Test (CVAT), the controlled oral word association test (COWAT), and the symbol digit modalities test (SDMT). Relative change scores were calculated as ((baseline - postoperative performance)/baseline). Group differences were analyzed using two-tailed multivariate analysis of variance (MANOVA), followed by ANOVAs and Bonferroni-adjusted pairwise comparisons. Results: A total of 105 participants were included (37 non-surgical, 34 propofol, 34 sevoflurane). MANOVA showed a significant group effect (Pillai's trace = 0.332, p < 0.001, η² = 0.196). The ANOVAs revealed significant differences in sustained attention (CVAT), verbal fluency (COWAT) and executive function (SDMT). The propofol group showed evident decline in sustained attention compared to non-surgical. In verbal fluency, non-surgical improved at day after, whereas both surgical groups showed no improvement, indicating worse performance. In SDMT the sevoflurane group had worse performance. Conclusions: Minor surgery under general anesthesia may lead to transient impairments in attention and learning at discharge, supporting the need for postoperative cognitive monitoring and individualized discharge decisions.