Postoperative delirium was associated with an over two-fold higher risk of severe cognitive decline over 6 years following major surgery (RR 2.15; 95% CI 1.35-3.42).
Cohort (n=560)
What are the cognitive trajectory patterns over 6 years after major noncardiac surgery in older adults, and what factors are associated with severe decline?
Among older adults undergoing major noncardiac surgery, 15% experience severe cognitive decline over 6 years, with postoperative delirium being a strong predictor.
Effect estimate: RR 2.15 (95% CI 1.35-3.42)
ABSTRACT Purpose (1) To describe cognitive trajectory patterns over 6 years after major surgery in older adults, and (2) To identify patient characteristics associated with severe cognitive decline. Methods Group‐based semiparametric trajectory modeling was performed on longitudinal cognitive data from the SAGES study, which enrolled patients aged ≥ 70 years undergoing major elective noncardiac surgery. Participants received comprehensive neuropsychological testing prior to surgery and postoperatively every 6–12 months up to 72 months. The primary outcome was change in general cognitive performance score, a composite of neuropsychological tests, at each of 11 follow‐up timepoints relative to baseline. Generalized linear models were used to assess the associations of pre‐surgical patient characteristics and incidence of postoperative delirium with cognitive trajectory. Results Of 560 participants, 326 were women (58%) and the average age was 76.7 (standard deviation 5.2) years. They underwent orthopedic (81%), gastrointestinal (13%), and vascular surgeries (6%), and 24% experienced postoperative delirium. We found the 3‐group cognitive trajectory model to be optimal, with the groups characterized as severe decline trajectory (SDT) (15% of the cohort), slight decline (59%), or stable (26%). Of pre‐surgical factors, age (relative risk RR: 1.06, 95% confidence interval CI 1.03–1.10 per 1 year increase) and 3MS (Modified‐Mini‐Mental) score (RR 0.95, 95% CI 0.92–0.99 per one point increase) were significantly associated with SDT. Participants who developed delirium had over two‐fold higher risk of SDT compared to those who did not (RR: 2.15, 95% CI: 1.35–3.42). Conclusions Among older adults undergoing major surgery, 15% experienced severe cognitive decline over the ensuing 6 years, 59% experienced slight decline, and 26% remained stable. Older age, baseline cognitive impairment, and delirium were associated with severe decline, with delirium having the strongest association. Our findings provide valuable information for older patients considering major surgery and may help clinicians target interventions.
Lu et al. (Sat,) conducted a cohort in Older adults undergoing major elective noncardiac surgery (n=560). Postoperative delirium vs. No postoperative delirium was evaluated on Change in general cognitive performance score, a composite of neuropsychological tests, at each of 11 follow-up timepoints relative to baseline (RR 2.15, 95% CI 1.35-3.42). Postoperative delirium was associated with an over two-fold higher risk of severe cognitive decline over 6 years following major surgery (RR 2.15; 95% CI 1.35-3.42).