Related Experiment Videos
Long-Term Cognitive and Functional Outcomes Following Postoperative Delirium and Liberal Fluid Fasting in Elderly
Patricia Knabe1, Janine Allmendinger1, Tobias Haas2
1Department of Anaesthesiology, LMU Munich University Hospital, 81377 Munich, Germany.
Insights
Postoperative delirium (POD) and fluid fasting duration did not significantly impact long-term cognitive or functional outcomes in elderly patients one year after surgery. Pre-existing neurodegenerative disease and polypharmacy were key predictors of adverse outcomes.
Area of Science:
- Geriatric Medicine
- Surgical Complications
- Cognitive Health
Background:
- Postoperative delirium (POD) is a common complication in elderly surgical patients.
- Liberalizing preoperative fluid fasting may reduce POD incidence.
- Limited evidence exists on long-term cognitive and functional outcomes after POD or liberal fluid fasting.
Purpose of the Study:
- To investigate the association of POD and fluid fasting regimens with cognitive performance and daily living activities twelve months post-surgery.
- To analyze long-term effects following the 'LFFgertrud' trial.
Main Methods:
- Follow-up study of 89 geriatric patients twelve months after elective trauma or orthopedic surgery.
- Utilized validated questionnaires: Short Blessed Test (SBT), EQ-5D-5L, Barthel Index (BI), and IQCODE.
- Assessed cognitive performance and activities of daily living.
Main Results:
- No statistically significant association found between POD/fluid fasting and long-term cognitive/functional outcomes.
- Neurodegenerative disease strongly predicted poorer outcomes (SBT, EQ-5D-5L, BI).
- Polymedication also emerged as a relevant predictor; trends suggested POD patients had lower cognitive performance and quality of life.
Conclusions:
- POD and fluid fasting duration were not significantly linked to one-year cognitive or functional outcomes.
- Pre-existing neurocognitive disease and polypharmacy are crucial factors for assessing long-term risks in older patients.
- Further research with larger sample sizes is needed to understand multifactorial recovery influences.
Abstract:
Background: Postoperative delirium (POD) is a frequent and serious complication in elderly surgical patients. Liberalising preoperative fluid fasting has been shown to reduce its incidence. However, evidence on long-term cognitive and functional outcomes following POD or liberal fluid fasting remains limited. Objectives: This study investigates whether POD and different fluid fasting regimens are associated with changes in cognitive performance and activities of daily living twelve months after surgery. Methods: As a follow-up to the prospective 'LFFgertrud' trial, 89 geriatric patients were contacted by phone twelve months after elective trauma or orthopaedic surgery (March 2023-February 2024). Participants completed four validated questionnaires assessing cognition and everyday functioning: the Short Blessed Test (SBT), EQ-5D-5L, Barthel index (BI), and the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE). Results: The hypotheses regarding the effects of POD and fluid fasting on cognitive and functional outcomes were not statistically supported. In contrast, neurodegenerative disease was strongly associated with poorer outcomes in three of the four follow-up measures (SBT: β = 1.27, p = 0.01; EQ-5D-5L: β = 1.43, p < 0.001; BI: β = -1.63, p < 0.001), and polymedication also emerged as a relevant predictor. Although not statistically significant, descriptive trends indicated that patients who developed POD showed lower cognitive performance and reduced quality of life at twelve months. Conclusions: POD and fluid fasting duration were not significantly associated with long-term cognitive or functional outcomes one year after hospitalisation. The findings highlight the importance of considering pre-existing neurocognitive disease and polypharmacy when assessing the risk of adverse long-term outcomes in older patients. Due to the multifactorial nature of recovery in this population, further research involving larger sample sizes is required in order to gain a better understanding of the factors that influence long-term outcomes.
