Subjective cognitive complaints in patients undergoing major non-cardiac surgery: a prospective single centre cohort trial

BACKGROUND: Few perioperative studies have assessed subjective cognitive complaint (SCC) in combination with neuropsychological testing. New nomenclature guidelines require both SCC and objective decline on cognitive testing. The objective of our study was to compare SCC and neuropsychological testing in an elderly surgical cohort. METHODS: This was a secondary analysis of a prospective cohort trial at a single urban medical centre. We included patients older than 65 yr, undergoing major non-cardiac surgery with general anaesthesia. Those with dementia or inability to consent were excluded, as were those undergoing emergency, cardiac, or intracranial procedures. Patients completed a neuropsychiatry battery before and 3 months after surgery. SCC was defined utilising the single question: 'do you feel that surgery and anaesthesia have impacted your clarity of thought?' Objective cognitive decline was defined as 1 standard deviation decline from the baseline of the cohort. RESULTS: Of the 120 patients who completed assessments, 16/120 (13%) had SCC after surgery, and 41/120 (34%) had objective decline. The sensitivity of SCC in relation to objective decline was 24% and specificity was 92%. Of the patients with SCC, 43.8% were screened positive for depression after surgery compared with 4.9% without SCC; P=0.001. CONCLUSIONS: Many patients with objective cognitive decline did not report SCC. There appears to be a relationship between SCC and depression. The use of SCC in surgical patients to define postoperative neurocognitive disorders needs to be better delineated. CLINICAL TRIAL REGISTRATION: NCT02650687.