Key result
Surgery and anesthesia exposure shows no link to worse cognition at 3 or 12 months.
Why the study?
Data are inconclusive as to whether cognitive impairment after major noncardiac surgery and critical illness is attributable to surgery and anesthesia exposure versus baseline factors and hospital course.
Does surgery and anesthesia exposure worsen cognitive impairment in ICU patients with critical illness?
Cohort (n=1,040)
Yes
Does surgery and anesthesia exposure worsen cognitive impairment in ICU patients with critical illness?
Cognitive impairment after major noncardiac surgery and critical illness is driven by baseline education level and in-hospital delirium, rather than the surgery and anesthesia exposure itself.
Surgery and anesthesia exposure may not worsen cognition in critically ill patients; leaves open delirium and education as primary drivers for prospective study.
OBJECTIVE: The aim of this study was to determine whether surgery and anesthesia exposure is an independent risk factor for cognitive impairment after major noncardiac surgery associated with critical illness. SUMMARY OF BACKGROUND DATA: Postoperative cognitive impairment is a prevalent individual and public health problem. Data are inconclusive as to whether this impairment is attributable to surgery and anesthesia exposure versus patients' baseline factors and hospital course. METHODS: In a multicenter prospective cohort study, we enrolled ICU patients with major noncardiac surgery during hospital admission and with nonsurgical medical illness. At 3 and 12 months, we assessed survivors' global cognitive function with the Repeatable Battery for the Assessment of Neuropsychological Status and executive function with the Trail Making Test, Part B. We performed multivariable linear regression to study the independent association of surgery/anesthesia exposure with cognitive outcomes, adjusting initially for baseline covariates and subsequently for in-hospital covariates. RESULTS: We enrolled 1040 patients, 402 (39%) with surgery/anesthesia exposure. Median global cognition scores were similar in patients with surgery/anesthesia exposure compared with those without exposure at 3 months (79 vs 80) and 12 months (82 vs 82). Median executive function scores were also similar at 3 months (41 vs 40) and 12 months (43 vs 42). Surgery/anesthesia exposure was not associated with worse global cognition or executive function at 3 or 12 months in models incorporating baseline or in-hospital covariates (P > 0.2). Higher baseline education level was associated with better global cognition at 3 and 12 months (P < 0.001), and longer in-hospital delirium duration was associated with worse global cognition (P < 0.02) and executive function (P < 0.01) at 3 and 12 months. CONCLUSIONS: Cognitive impairment after major noncardiac surgery and critical illness is not associated with the surgery and anesthesia exposure but is predicted by baseline education level and in-hospital delirium.
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Hughes et al. (2016) conducted a cohort in Critical illness (n=1,040). Surgery and anesthesia exposure vs. Nonsurgical medical illness (no surgery/anesthesia exposure) was evaluated on Global cognitive function and executive function at 3 and 12 months (p=> 0.2). Surgery and anesthesia exposure was not associated with worse global cognition or executive function at 3 or 12 months compared with no exposure (P > 0.2).
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