Risk factors for postoperative cognitive dysfunction in neurosurgical patients

Background: the influence of various risk factors on the development of postoperative cognitive dysfunction in neurosurgeon patients requires study to reduce this complication. Aims: this study assessed the influence of extra- and intraoperative factors on the development of postoperative cognitive dysfunction (POCD) in neurosurgical patients. Methods: The study was conducted among neurosurgical patients who underwent spine surgery at the Neurosurgical Department of the Regional clinical hospital No. 2, Tyumen, Russia. Cognitive functions were assessed before surgery and on the 3rd day after surgery using the MoCA scales, the Isaac test set and the Munsterberg test. Pearson coefficients and point biserial correlation coefficients were calculated for the following risk factors: type and duration of anesthesia, drugs for anesthesia and muscle relaxation, type of surgery, age, body mass index (BMI), number of years of education, presence of arterial hypertension (AH), diabetes mellitus (DM), smoking. Results: A significant positive correlation was found between the development of POCD and age (r=0.53, p0.01), moderate correlation with BMI (r=0.35, p0.01) and the presence of hypertension (r=0.42, p0.05). A moderate negative correlation was found between the number of years of education and the development of POCD (r=-0.36, p0.01). The relationship between the presence of diabetes and POCD had reliably low correlation indices. The coefficients of the relationship between smoking and the duration of surgery have a low level of significance, which does not allow us to fully interpret the obtained results as reliable. The type of surgery and the duration of anesthesia did not correlate with the development of POCD (r0.1, p0.01). A moderate correlation was found with the use of a combination of desflurane + fentanyl as anesthesia (r = 0.31, p 0.05), a slight correlation with the use of a combination of sevoflurane + fentanyl + ketamine (r = 0.25, p 0.05). The use of fentanyl together with sevoflurane (r = 0.07), propofol (r = -0.1), sodium oxidate (r = 0.05) does not lead to the occurrence of PCOD (p 0.05). Conclusions: Old age, high BMI, hypertension, low level of education, use of combinations of drugs desflurane + fentanyl, sevoflurane + fentanyl + ketamine increase the risk of developing POCD.