Evaluation of Postoperative Cognitive Dysfunction and Its Risk Factors in Elderly Patients Undergoing Elective Non-Cardiac Surgery: A Prospective Observational Study.

Abstract

Objectives: This study aimed to evaluate the incidence, course, and potential risk factors of postoperative cognitive dysfunction (POCD) in elderly patients undergoing elective non-cardiac surgery.

Methods: A prospective observational study was conducted on 35 patients aged 60 years and older who underwent elective non-cardiac surgery under general or regional anesthesia. Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA) test preoperatively, at 24 hours, and on postoperative day 30. Demographic characteristics, comorbidities, perioperative events, and anesthesia-related factors were recorded.

Results: The mean preoperative MoCA score was 20.9±3.2, which decreased significantly to 18.0±2.6 at 24 hours (p<0.001) and improved to 22.7±2.7 by postoperative day 30 (p<0.001). The incidence of cognitive dysfunction (MoCA <21) was 42.9% preoperatively, 85.7% at 24 hours, and 20.0% at day 30. No significant associations were found between POCD and comorbidities, anesthesia type, intraoperative hypotension, bleeding, transfusion, or narcotic use (p>0.05). However, preoperative cognitive performance was lower among patients with lower education levels, and postoperative day-30 scores were significantly lower among smokers (p=0.043).

Conclusion: POCD was common in the early postoperative period but largely resolved by day 30. Smoking and low educational level were associated with poorer cognitive outcomes. Larger multicenter studies are needed to further clarify risk factors and long-term neurocognitive trajectories in elderly surgical patients.