What question did this study set out to answer?

To evaluate whether surgical invasiveness and anesthetic technique alter the incidence of postoperative cognitive dysfunction at seven days and three months.

April 9, 2011Anesthesia & Analgesia

Postoperative Cognitive Dysfunction Is Independent of Type of Surgery and Anesthetic

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Why the study?

Does the type of surgery and anesthetic affect the incidence of postoperative cognitive dysfunction at 3 months in older patients?

Population

678 subjects, including old and elderly patients undergoing coronary angiography under sedation, total hip…

Comparison

Coronary angiography under sedation, total hip… vs Nonoperative control group and cross-comparisons…

Design

Cohort

Follow-up

3 months

Authors

LELisbeth EveredCross-Cutting Cardiology DSDavid A. ScottSt Vincent's Hospital BSBrendan SilbertSt John of God Subiaco Hospital

Discussion

Member takes

Implication

POCD rates similar across procedures; hypothesis-generating for non-surgical risk factors in older adults.

Key Points

To evaluate whether surgical invasiveness and anesthetic technique alter the incidence of postoperative cognitive dysfunction at seven days and three months.
Assessed 644 surgical patients across three prospective cohorts (coronary angiography under sedation, total hip replacement under general anesthesia, and coronary bypass under general anesthesia with cardiopulmonary bypass) alongside 34 nonoperative controls.
Administered a battery of eight neuropsychological tests at baseline, 7 days, and 3 months postoperatively, calculating cognitive decline via the reliable change index.
At day 7, postoperative cognitive dysfunction was significantly lower after total hip replacement (17%, n=162) than after coronary artery bypass graft surgery (43%, n=281; adjusted OR 0.2, 95% CI: 0.1 to 0.4; P<0.01).
At 3 months, overall cognitive dysfunction across groups (n=636) was 17% (21% for angiography, 16% for hip replacement, and 16% for bypass surgery), with no statistically significant differences detected (adjusted OR 1.21, 95% CI: 0.94 to 1.55; P=0.13).

Structured PICO

Does the type of surgery and anesthetic affect the incidence of postoperative cognitive dysfunction at 3 months in older patients?

Population

678 subjects (644 patients and 34 nonoperative controls), including old and elderly patients undergoing coronary angiography (CA) under sedation, total hip joint replacement (THJR) under general anesthesia, or coronary artery bypass graft (CABG) surgery under general anesthesia.

Intervention

Coronary angiography (CA) under sedation, total hip joint replacement (THJR) under general anesthesia, or coronary artery bypass graft (CABG) surgery under general anesthesia.

Comparator

Nonoperative control group and cross-comparisons between the three surgical/procedural groups.

Outcome

Incidence of postoperative cognitive dysfunction (POCD) at 7 days and 3 months postoperatively, calculated using reliable change index from eight neuropsychological tests.patient reported

Postoperative cognitive dysfunction at 3 months is independent of the type of surgical procedure or anesthetic used, occurring in approximately 17% of older patients.

Cite This Study

Evered et al. (2011) studied this question.

synapsesocial.com/papers/6a707bd3a528af2d65c38fa1 https://doi.org/10.1213/ane.0b013e318215217e

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Postoperative Cognitive Dysfunction Is Independent of Type of Surgery and Anesthetic

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Postoperative Cognitive Dysfunction Is Independent of Type of Surgery and Anesthetic

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Also Consider

Also Consider