Key result
Noncardiac surgery linked to one-week cognitive dysfunction in ~37% of patients with severe systemic disease.
Why the study?
The relevance of surgery and other factors to the incidence of postoperative cognitive dysfunction in patients with severe systemic disease was unclear.
Does noncardiac surgery increase the incidence of cognitive dysfunction at 7 days in patients with severe systemic disease compared to nonsurgical controls?
Observational (n=133)
Does noncardiac surgery increase the incidence of cognitive dysfunction at 7 days in patients with severe systemic disease compared to nonsurgical controls?
Absolute Event Rate: 37.4% vs 15.4%
In patients with severe systemic disease, lower baseline cognitive function is an independent predictor of cognitive dysfunction 7 days after noncardiac surgery.
May signal heightened early cognitive vulnerability after noncardiac surgery in severe disease; leaves open causality and long-term impact.
OBJECTIVE: To determine the relevance of surgery and other causative factors to the incidence of postoperative cognitive dysfunction (POCD) in patients with severe systemic disease. METHODS: This observational study included 107 noncardiac surgical patients and 26 nonsurgical control subjects, all of whom had an American Society of Anesthesiologists physical classification status of 3. Cognitive assessment was performed preoperatively and 7 days postoperatively, or with a 7-day interval for the control group. POCD was calculated as a combined Z-score. Mini Mental State Examination (MMSE) was used to exclude patients with pre-existing cognitive deficit (MMSE score ≤ 23). Surgical and other factors including duration of surgery/anaesthesia and length of stay in the intensive care unit (ICU) were recorded. RESULTS: After 7 days, POCD was found in 40/107 (37.4%) surgical patients compared with 4/26 (15.4%) nonsurgical controls. Preoperative MMSE score, duration of surgery/anaesthesia, and length of stay in the ICU and hospital were associated with POCD. Logistic regression analysis revealed that preoperative MMSE score was an independent predictor of POCD. CONCLUSION: Lower baseline MMSE score was the only independent predictor for POCD in patients with severe systemic disease.
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Radtke et al. (2012) conducted an observational in Severe systemic disease (n=133). Noncardiac surgery vs. Nonsurgical controls was evaluated on Postoperative cognitive dysfunction (POCD) at 7 days. Noncardiac surgery was associated with cognitive dysfunction at 7 days in 37.4% of patients with severe systemic disease, compared to 15.4% of nonsurgical controls.
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