Early postoperative cognitive impairment after trauma surgery: a prospective cohort study

Objective. To improve the diagnosis of early postoperative cognitive disorders (agitation and emergence delirium) considering risk factors of these undesirable events after general anesthesia in trauma surgery. Material and methods. A double-center prospective cohort study included patients aged 45—74 years who underwent elective trauma surgery (large joint replacement, spinal fusion surgery, transpedicular fixation of vertebrae) under general anesthesia. The following data were analyzed: demographic indicators, concomitant diseases, background therapy, preoperative laboratory tests and scores (ASA, MoCA, AUDIT, CFS, HADS-A, RASS). We analyzed RASS, CAM-ICU and CAM-ICU-7, NRS and BPS scores at the end of surgery after weaning from ventilator and in postoperative period. Statistical analysis was carried out using the SPSS Statistics 27.0.1.0 software. Results. The study included 200 people between March 2021 and June 2022. Independent predictors of agitation were increased preoperative hemoglobin (>144 g/l) and glucose (>5.6 mmol/l), as well as intraoperative infusion of fentanyl >0.4 mg. Risk factors of emergence delirium were older age (>60 years) and high CFS score (>4). Postoperative delirium was significantly more common in patients with positive results on motor scales. Positive results on delirious scales were associated with frequent transferring to the ICU for a day, longer hospital-stay and frequent postoperative delirium. Conclusion. Emergence delirium is an independent risk factor of postoperative delirium in contrast to agitation.