Key result
Major surgery is linked to ~5 months of cognitive decline, less than medical admissions or stroke.
Why the study?
The study was conducted to quantify the association between major surgery and the age-related cognitive trajectory.
Does major surgery accelerate cognitive decline in adults?
Cohort (n=7,532)
Does major surgery accelerate cognitive decline in adults?
Major surgery is associated with a small, long-term cognitive decline that is less profound than the decline following major medical admissions.
Places surgery-related cognitive changes in perspective versus medical admissions or stroke; leaves open causality and generalizability in observational data.
OBJECTIVE: To quantify the association between major surgery and the age related cognitive trajectory. DESIGN: Prospective longitudinal cohort study. SETTING: United Kingdom. PARTICIPANTS: 7532 adults with as many as five cognitive assessments between 1997 and 2016 in the Whitehall II study, with linkage to hospital episode statistics. Exposures of interest included any major hospital admission, defined as requiring more than one overnight stay during follow-up. MAIN OUTCOMES MEASURES: The primary outcome was the global cognitive score established from a battery of cognitive tests encompassing reasoning, memory, and phonemic and semantic fluency. Bayesian linear mixed effects models were used to calculate the change in the age related cognitive trajectory after hospital admission. The odds of substantial cognitive decline induced by surgery defined as more than 1.96 standard deviations from a predicted trajectory (based on the first three cognitive waves of data) was also calculated. RESULTS: After accounting for the age related cognitive trajectory, major surgery was associated with a small additional cognitive decline, equivalent on average to less than five months of aging (95% credible interval 0.01 to 0.73 years). In comparison, admissions for medical conditions and stroke were associated with 1.4 (1.0 to 1.8) and 13 (9.6 to 16) years of aging, respectively. Substantial cognitive decline occurred in 2.5% of participants with no admissions, 5.5% of surgical admissions, and 12.7% of medical admissions. Compared with participants with no major hospital admissions, those with surgical or medical events were more likely to have substantial decline from their predicted trajectory (surgical admissions odds ratio 2.3, 95% credible interval 1.4 to 3.9; medical admissions 6.2, 3.4 to 11.0). CONCLUSIONS: Major surgery is associated with a small, long term change in the average cognitive trajectory that is less profound than for major medical admissions. The odds of substantial cognitive decline after surgery was about doubled, though lower than for medical admissions. During informed consent, this information should be weighed against the potential health benefits of surgery.
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Krause et al. (2019) conducted a cohort in Cognitive decline (n=7,532). Major surgical admission vs. No major hospital admissions was evaluated on Global cognitive score (MD -0.014, 95% CI -0.029 to 0.000). Major surgery was associated with a small long-term cognitive decline of -0.014 units, equivalent to less than five months of cognitive aging, which was substantially less than the decline seen after medical admissions or stroke.
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