Does Postoperative Cognitive Decline Result in New Disability After Surgery?
- 6 March 2020
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Annals of Surgery
- Vol. 274 (6), e1108-e1114
- https://doi.org/10.1097/sla.0000000000003764
Abstract
Objective: Establish whether POCD is associated with new disability after surgery, which would inform whether POCD impacts patient-centered outcomes. Background: POCD is a decline in neuropsychiatric tests scores from presurgical baseline which occurs in approximately 15% of older patients 3 months after surgery. POCD is a research construct meant to investigate patient and family reports of older adults who were “never the same after surgery.” However, many patients with POCD do not perceive difficulty with thinking and memory, and the question remains whether POCD impacts patient function. Methods: We performed a prospective cohort study of 167 older adults undergoing major noncardiac surgery (requiring at least a 2-day hospital stay). Exclusion criteria were: history of dementia, cardiac or intracranial procedure, inability to consent for themselves, or emergency surgery. We administered formal neuropsychiatric testing (Alzheimer Disease Research Center UDS battery), basic and instrumental activities of daily living (Alzheimer Disease Research Center IADLs), pain (geriatric pain measure), and depression screening (hospital depression and anxiety scale) before and 3 months after surgery. We recorded all patient refined diagnostic related groups codes, blood pressure, anesthetics and narcotics administered, surgical and anesthesia duration, and measured complications and severity, length of stay, and readmissions. Results: Patients with POCD (21/167, 14.1%) had twice the proportion of new impairment in IADL as compared to those without POCD (57% vs 27%, P = .01). The most common areas of decline were social activities, ability to find items around the house, remember appointments, shop and pay for items, do laundry, drive a car/use public transport, and do housework. Predictors of IADL change after surgery included POCD, presurgical cognition, presurgical function, postoperative depression, and the development of postoperative complications. Conclusions: Patients with POCD experience a much higher incidence of new disability after surgery. Baseline cognitive or functional limitations are also risk factors for new disability. Many patients are not aware of their limitations before surgery. Future study is needed to identify practical ways to routinely screen patients and reduce risk. Patients need to be informed of their risk for new disability after surgery to inform their medical decision making.Keywords
This publication has 33 references indexed in Scilit:
- Reliability of the American Society of Anesthesiologists physical status scale in clinical practiceBritish Journal of Anaesthesia, 2014
- The influence of propofol or desflurane on postoperative cognitive dysfunction in patients undergoing coronary artery bypass surgery*Anaesthesia, 2011
- Development and Feasibility of a Scale to Assess Postoperative RecoveryAnesthesiology, 2010
- The Alzheimer's Disease Centers' Uniform Data Set (UDS) The Neuropsychologic Test BatteryAlzheimer Disease & Associated Disorders, 2009
- Research electronic data capture (REDCap)—A metadata-driven methodology and workflow process for providing translational research informatics supportJournal of Biomedical Informatics, 2008
- Type and Severity of Cognitive Decline in Older Adults after Noncardiac SurgeryAnesthesiology, 2008
- Depression and cognition in older adultsCurrent Opinion in Psychiatry, 2008
- Classification of Surgical ComplicationsAnnals of Surgery, 2004
- The validity of the Hospital Anxiety and Depression ScaleJournal of Psychosomatic Research, 2002
- “Mini-mental state”: A practical method for grading the cognitive state of patients for the clinicianJournal of Psychiatric Research, 1975