老年非心脏手术患者术后神经认知障碍的患病率：系统回顾和荟萃分析

IF 5 2区医学 Q1 ANESTHESIOLOGY

Journal of Clinical Anesthesia Pub Date : 2025-04-01 DOI:10.1016/j.jclinane.2025.111830

Wendy W.Y. Huang HBSc , Shirley Fan , Wei-Ya Li , Vetri Thangavelu HBSc , Aparna Saripella , Marina Englesakis MLIS , Ellene Yan HBSc , Frances Chung MBBS MD

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引用次数: 0

摘要

研究目的：越来越多的接受手术的老年人由于多病和年龄相关的变化而面临更高的神经认知障碍风险。先前的综述估计了术后神经认知障碍或认知功能障碍（POCD）的患病率，而没有考虑样本量或研究质量。该人群中POCD的流行情况有待进一步调查。本系统综述和荟萃分析应用系统加权来估计老年非心脏手术患者POCD的总患病率。设计系统回顾和荟萃分析。设置MEDLINE， MEDLINE ePub, Embase， Cochrane中央对照试验注册库和Cochrane系统评价数据库的相关文章。年龄≥60岁的非心脏手术患者。干预术中认知评估。主要观察指标为POCD的患病率。主要结果纳入39项研究（n = 12,921），平均年龄70.0±8.9岁，女性44.3%。POCD的总患病率在第7天为23% (95% CI: 20%, 27%)， 1个月为16% (95% CI: 7%, 25%)， 3个月为10% (95% CI: 8%, 13%)， 1年为3% （95% CI: 2%, 4%）。我们的荟萃回归显示，腹部手术第7天（β = 0.13, 95% CI: 0.03-0.22, P = 0.01）和第3个月(β = 0.49, 95% CI: 0.40-0.58, P <；0.001)，与骨科手术相比。结论老年非心脏手术人群POCD的总体患病率在第7天、第1个月、第3个月和第1年分别为23%、16%、10%和3%。腹部手术的POCD患病率高于骨科手术。POCD的巨大风险要求进行认知筛查、风险缓解和干预以改善手术结果。通过术前常规的认知筛查和处理可改变的危险因素，可以显著降低POCD的发病率和影响，提高患者的预后和康复。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

Prevalence of postoperative neurocognitive disorders in older non-cardiac surgical patients: A systematic review and meta-analysis

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Prevalence of postoperative neurocognitive disorders in older non-cardiac surgical patients: A systematic review and meta-analysis

Study objective

The growing number of older persons undergoing surgery are at a higher risk of neurocognitive disorder due to multimorbidity and age-related changes. Previous reviews estimated postoperative neurocognitive disorder or cognitive dysfunction (POCD) prevalence without accounting for the sample size or study quality. The prevalence of POCD in this population requires further investigation. This systematic review and meta-analysis applies systematic weighting to estimate the pooled prevalence of POCD in older non-cardiac surgical patients.

Design

Systematic review and meta-analysis.

Setting

MEDLINE, MEDLINE ePub, Embase, Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews for relevant articles.

Patients

Non-cardiac surgical patients aged ≥60 years old.

Interventions

Perioperative cognitive assessments.

Measurement

The primary outcome was the prevalence of POCD.

Main results

Thirty-nine studies (n = 12,921) were included with mean age of 70.0 ± 8.9 years and 44.3 % women. The overall prevalence of POCD was 23 % (95 % CI: 20 %, 27 %) at day 7, 16 % (95 % CI: 7 %, 25 %) at 1 month, 10 % (95 % CI: 8 %, 13 %) at 3 months and 3 % (95 % CI: 2 %, 4 %) at 1 year. Our meta-regression showed a higher prevalence of POCD in abdominal surgeries at day 7 (β = 0.13, 95 % CI: 0.03–0.22, P = 0.01) and 3 months (β = 0.49, 95 % CI: 0.40–0.58, P < 0.001), versus orthopedic surgeries.

Conclusions

The overall prevalence of POCD in older non-cardiac surgical populations was 23 %, 16 %, 10 %, and 3 % at day 7, 1 month, 3 months, and 1 year, respectively. Abdominal surgery had a higher prevalence of POCD than orthopedic surgery. The substantial risk of POCD calls for cognitive screening, risk mitigation and interventions to improve surgical outcomes. Through routine preoperative cognitive screening and addressing modifiable risk factors, the incidence and impact of POCD can be markedly reduced, enhancing patient outcomes and recovery.

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来源期刊

Journal of Clinical Anesthesia 医学-麻醉学

CiteScore

7.40

自引率

4.50%

发文量

346

审稿时长

23 days

期刊介绍： The Journal of Clinical Anesthesia (JCA) addresses all aspects of anesthesia practice, including anesthetic administration, pharmacokinetics, preoperative and postoperative considerations, coexisting disease and other complicating factors, cost issues, and similar concerns anesthesiologists contend with daily. Exceptionally high standards of presentation and accuracy are maintained. The core of the journal is original contributions on subjects relevant to clinical practice, and rigorously peer-reviewed. Highly respected international experts have joined together to form the Editorial Board, sharing their years of experience and clinical expertise. Specialized section editors cover the various subspecialties within the field. To keep your practical clinical skills current, the journal bridges the gap between the laboratory and the clinical practice of anesthesiology and critical care to clarify how new insights can improve daily practice.