Cerebral Oxygenation and Neurocognitive Outcomes in Lumbar Surgery: A NIRS Study

Objective: To evaluate whether management of cerebral desaturation using a near-infrared spectroscopy (NIRS) algorithms on the incidence of postoperative delirium (POD) and postoperative cognitive dysfunction (POCD) in patients undergoing prone lumbar surgery.Method: Participants in this prospective trial were randomly assigned to either an intervention arm (receiving NIRS-guided care) or a control arm.We excluded individuals with pre-existing neuropsychiatric diagnoses.Baseline cognitive function was assessed, we administered the Mini-Mental State Examination alongside Addenbrooke's Cognitive Examination-Revised evaluated at one week, three months, and six months post-surgery.Results: A total of 52 participants (comprising 27 males and 25 females) were enrolled, with an average age of 55.6 ± 7.1 years.Baseline demographic and clinical characteristics were comparable.Cerebral oxygen saturation drops of 20% or more occurred in 27% of the control group and 35% of the study group.Regarding neurocognitive outcomes, the study group demonstrated significantly improved test scores at the one-week (p=0.013) and three-month (p=0.018)marks compared to controls, though the difference at six months (p=0.064) was not statistically significant.Notably, POD was not detected in any patient across both groups.Conclusion: While POD was not observed in our study population, our results indicate that reducing the duration of cerebral desaturation using a NIRS-based algorithm is associated with better neurocognitive outcomes.Conventional anesthetic management alone did not fully prevent postoperative cognitive decline in the control group, whereas NIRS-guided reduction of cerebral desaturation duration was associated with improved neurocognitive outcomes and a lower incidence of POCD.