Donepezil Treatment Does Not Improve Postoperative Delirium, Medical, or Surgical Outcomes Following Lumbar Spine Surgery: A Propensity-Matched Analysis.

Background context: Patients with preoperative cognitive impairment, defined as a diagnosis of dementia or mild cognitive impairment (MCI), have been associated with inferior perioperative lumbar spine surgery outcomes when compared to cognitively normal patients. Donepezil is currently used to improve mentation and memory in patients with cognitive impairment (CI), however there is an absence of literature regarding its impact on postoperative complications following spine surgery.

Purpose: To assess the impact of Donepezil treatment on postoperative delirium, medical complications, and surgical wound outcomes following lumbar spine surgery in patients with CI.

Study design: Retrospective study utilizing the TriNetX Research Network.

Patient sample: Patients were sectioned into two groups: (1) those treated with Donepezil and (2) those not treated with any acetylcholinesterase inhibitors.

Outcome measures: The primary outcome was 30-day postoperative delirium. The secondary outcome was a composite measure of medical complications including urinary tract infection, pneumonia, deep vein thrombosis, and pulmonary embolism. The exploratory outcomes were emergency department visits and a composite measure of surgical wound complications.

Methods: The TriNetX Research Network was queried to identify patients diagnosed with either dementia or MCI who underwent lumbar spine surgery for treatment of lumbar spondylolisthesis or stenosis. Propensity score matching was performed to adjust for age, race, gender, and comorbidities, thereby controlling for potential confounders. Postoperative outcomes were identified utilizing corresponding diagnostic and procedural codes.

Results: Following propensity score matching, a total of 832 patients were included in the final analysis (mean age: 74.2 years; SD: 7.18; 390 [46.9%] male), with 416 patients in both the Donepezil-treated and non-treated cohorts. There were no statistically significant differences between groups in the incidence of postoperative delirium at 15 days (OR: 1.000, 95% CI [0.601-1.665]) 30 days (OR: 0.967, 95% CI [0.583-1.605]) or 90 days (OR: 1.000, 95% CI [0.605-1.653]). Similarly, rates of composite medical complications did not differ at 15 days (OR: 0.954, 95% CI [0.623-1.460]), 30 days (OR:0.979, 95% CI [0.657-1.461]), or 90 days (OR: 0.832, 95% CI [0.581-1.191]). Composite surgical wound complications were also comparable between cohorts at 15 days (OR: 1.000, 95% CI (0.412-2.428]), 30 days (OR: 1.414, 95% CI [0.621-3.220]), and 90 days (OR: 1.131, 95% CI [0.568-2.249]). Further, no differences in emergency department visits were observed at 15 days (OR: 1.223 95% CI [0.656-2.281]), 30 days (OR: 1.123, 95% CI [0.700-1.801]), or 90 days (OR: 0.875, 95%CI [0.596-1.284]) CONCLUSIONS: This large retrospective, propensity score-matched analysis indicates that Donepezil, despite its therapeutic role in enhancing cognitive function in patients with pre-existing cognitive impairment, does not significantly reduce the incidence of postoperative delirium, medical complications, emergency department visits, or surgery-related complications following lumbar spine surgery.