Risk Factors for Postoperative Cognitive Decline After Orthopedic Surgery in Elderly Chinese Patients: A Retrospective Cohort Study

IF 3.6 3区医学

Clinical Interventions in Aging Pub Date : 2024-03-19 DOI:10.2147/cia.s436349

Xian Li, Hong Lai, Peng Wang, Shuai Feng, Xuexin Feng, Chao Kong, Dewei Wu, Chunlin Yin, Jianghua Shen, Suying Yan, Rui Han, Jia Liu, Xiaoyi Ren, Ying Li, Lu Tang, Dong Xue, Ying Zhao, Hao Huang, Xiaoying Li, Yanhong Zhang, Xue Wang, Chunxiu Wang, Ping Jin, Shibao Lu, Tianlong Wang, Guoguang Zhao, Chaodong Wang

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引用次数: 0

Abstract

Purpose: We aimed to identify the risk factors for postoperative cognitive decline (POCD) by evaluating the outcomes from preoperative comprehensive geriatric assessment (CGA) and intraoperative anesthetic interventions.
Patients and Methods: Data used in the study were obtained from the Aged Patient Perioperative Longitudinal Evaluation–Multidisciplinary Trial (APPLE-MDT) cohort recruited from the Department of Orthopedics in Xuanwu Hospital, Capital Medical University between March, 2019 and June, 2022. All patients accepted preoperative CGA by the multidisciplinary team using 13 common scales across 15 domains reflecting the multi-organ functions. The variables included demographic data, scales in CGA, comorbidities, laboratory tests and intraoperative anesthetic data. Cognitive function was assessed by Montreal Cognitive Assessment scale within 48 hours after admission and after surgery. Dropping of ≥ 1 point between the preoperative and postoperative scale was defined as POCD.
Results: We enrolled 119 patients. The median age was 80.00 years [IQR, 77.00, 82.00] and 68 patients (57.1%) were female. Forty-two patients (35.3%) developed POCD. Three cognitive domains including calculation (P = 0.046), recall (P = 0.047) and attention (P = 0.007) were significantly worsened after surgery. Univariate analysis showed that disability of instrumental activity of daily living, incidence rate of postoperative respiratory failure (PRF) ≥ 4.2%, STOP-Bang scale score, Caprini risk scale score and Sufentanil for maintenance of anesthesia were different between the POCD and non-POCD patients. In the multivariable logistic regression analysis, PRF ≥ 4.2% (odds ratio [OR] = 2.343; 95% confidence interval [CI]: 1.028– 5.551; P = 0.046) and Sufentanil for maintenance of anesthesia (OR = 0.260; 95% CI: 0.057– 0.859; P = 0.044) was independently associated with POCD as risk and protective factors, respectively.
Conclusion: Our study suggests that POCD is frequent among older patients undergoing elective orthopedic surgery, in which decline of calculation, recall and attention was predominant. Preoperative comprehensive geriatric assessments are important to identify the high-risk individuals of POCD.

Keywords: cognitive dysfunction, postoperative cognitive complications, orthopedic surgery, comprehensive geriatric assessment, risk factors

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中国老年骨科患者术后认知能力下降的风险因素：回顾性队列研究

目的：我们旨在通过评估术前老年综合评估（CGA）和术中麻醉干预的结果，确定术后认知功能下降（POCD）的风险因素：研究数据来自首都医科大学宣武医院骨科于2019年3月至2022年6月期间招募的老年患者围手术期纵向评估-多学科试验（APPLE-MDT）队列。所有患者均接受多学科团队采用13个通用量表、15个反映多器官功能的领域进行的术前CGA。变量包括人口统计学数据、CGA 量表、合并症、实验室检查和术中麻醉数据。认知功能在入院后 48 小时内和手术后通过蒙特利尔认知评估量表进行评估。术前和术后评分下降≥1分定义为POCD：我们共招募了 119 名患者。中位年龄为 80.00 岁 [IQR，77.00，82.00]，68 名患者（57.1%）为女性。42名患者（35.3%）出现了 POCD。术后，包括计算（P = 0.046）、回忆（P = 0.047）和注意力（P = 0.007）在内的三个认知领域明显恶化。单变量分析显示，POCD 和非 POCD 患者的日常生活器械活动残疾率、术后呼吸衰竭（PRF）发生率≥ 4.2%、STOP-Bang 评分、Caprini 风险评分和维持麻醉的舒芬太尼均有差异。在多变量逻辑回归分析中，PRF ≥ 4.2% （几率比 [OR] = 2.343; 95% 置信区间 [CI]：1.028- 5.551; P = 0.046）和用于维持麻醉的舒芬太尼（OR = 0.260; 95% CI: 0.057- 0.859; P = 0.044）分别作为风险和保护因素与 POCD 独立相关：我们的研究表明，POCD 在接受择期骨科手术的老年患者中很常见，其中主要表现为计算能力、记忆力和注意力的下降。术前综合老年评估对于识别 POCD 的高危人群非常重要。关键词：认知功能障碍；术后认知并发症；骨科手术；综合老年评估；风险因素

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来源期刊

Clinical Interventions in Aging GERIATRICS & GERONTOLOGY-

CiteScore

6.20

自引率

2.80%

发文量

193

期刊介绍： Clinical Interventions in Aging, is an online, peer reviewed, open access journal focusing on concise rapid reporting of original research and reviews in aging. Special attention will be given to papers reporting on actual or potential clinical applications leading to improved prevention or treatment of disease or a greater understanding of pathological processes that result from maladaptive changes in the body associated with aging. This journal is directed at a wide array of scientists, engineers, pharmacists, pharmacologists and clinical specialists wishing to maintain an up to date knowledge of this exciting and emerging field.