[Postoperative cognitive disorders in traumatic hip surgery in elderly subjects].

The aging population inevitably leads to an increase in the number of surgical procedures performed on older people. The effects of anesthesia coupled with surgery are recognized as precipitating a post-operative cognitive impairment whose etiology seems to be multifactorial with a predominance of the inflammatory cause related to surgery. Objectives. The main objective of our work is to determine the incidence and risk factors of cognitive decline after hip injury surgery. This is the continuation of a publication focusing on the epidemiological and evolutionary profile of the same cohort [1]. Our study, descriptive observational prospective and mono-centric, collected a sample of 89 patients. It is carried out at the orthopedic trauma department of the Annaba University Hospital Center, over a period of 24 months. The study protocol consists in evaluating the cognitive state, for each patient, preoperatively with a post-operative follow-up for a year, using four tests [the Mini-Mental State Examination (MMSE), the Dubois Test, the Clock Test (TDH) and the scale of everyday instrumental activities (Instrumental Activities of Daily Living, IADL4)]. This postoperative, longitudinal cognitive follow-up is carried out on the 1st, 3rd, 6th, 12th postoperative months. Assessment of the cognitive state in pre and postoperative by a battery of four tests, reveal a high incidence of postoperative cognitive disorders (PCD) in this surgical population, it is about 27% at one month, followed by a gradual improvement in neurocognitive abilities to complete cognitive recovery. The incidence of PCD is estimated at 17% at 3 months, 9% at 6 months and only 1% at 12 months. Out of 30 risk factors analyzed, only three are retained (after logistic regression). This is advanced age (OR = 7.135, 95% CI = 2.4-21.2), the delay in management (OR = 4.65 with a 95%CI = 1,73-12,64) and the multimodal analgesia with OR = 0.30 and 95%CI = 0,11-0,78). There is currently no curative treatment available for PCD. Only a preventive preoperative cognitive preparation approach could be considered for the management of PCD; it is based on the evaluation of the impact of PCD on patients' work and personal lives, as well as the implementation of cognitive stimulation programs.