Prevalence of neurocognitive disorders 5 years after elective orthopaedic surgery

IF 7.5 1区医学 Q1 ANESTHESIOLOGY Anaesthesia Pub Date : 2024-07-10 DOI:10.1111/anae.16365

Kelly J. Atkins, Brendan Silbert, David A. Scott, Lis A. Evered

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Abstract

Background

Peri-operative neurocognitive disorders are one of the most common complications affecting older adults after anaesthesia and surgery. It is not clear how exposure to surgery and anaesthesia contributes to the prevalence of long-term neurocognitive disorders. This study aimed to report the prevalence of neurocognitive disorders, and explore pre-operative factors associated with neurocognitive disorders 5 years after elective orthopaedic surgery.

Methods

A prospective, 5-year longitudinal, cohort study was performed recruiting patients (aged ≥ 60 y) undergoing elective orthopaedic surgery and a contemporaneous non-surgical control group. Neurocognitive disorder was evaluated and classified at baseline and 5-year review incorporating: self- and informant-reported cognition; functional participation; and performance on neuropsychological tests.

Results

Recruitment at 5-year follow-up included 195 patients and 21 control participants. In the patient cohort the prevalence of neurocognitive disorder was 38.1% (n = 75), with 61 (30.1%) meeting the criteria for mild neurocognitive disorder and 14 (7.1%) for major neurocognitive disorder. At 5-year follow-up, 121 (61.4%) patients were classified with a neurocognitive disorder, with 88 (44.7%) characterised with mild neurocognitive disorder and 33 (16.8%) with major neurocognitive disorder. Age (odds ratio (95%CI) 1.07 (1.02–1.13); p = 0.01) and baseline cognitive impairment (odds ratio (95%CI) 2.1 (1.06–4.15); p = 0.03) were significant predictors of neurocognitive disorder 5 years after surgery.

Conclusion

More than half of older adult patients had some form of neurocognitive disorder 5 years after elective orthopaedic surgery. Surgery and anaesthesia may be associated with the trajectory of cognitive decline in at-risk older adults, including those with pre-operative cognitive impairment. Cognitive screening should be factored into pre-operative assessments of older adults to inform subsequent care.

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选择性骨科手术 5 年后神经认知障碍的患病率。

背景：围手术期神经认知障碍是老年人麻醉和手术后最常见的并发症之一。目前尚不清楚手术和麻醉如何导致长期神经认知障碍的发生。本研究旨在报告神经认知障碍的患病率，并探讨择期骨科手术 5 年后与神经认知障碍相关的术前因素：一项为期 5 年的前瞻性纵向队列研究招募了接受择期骨科手术的患者（年龄≥ 60 岁）和同期非手术对照组。在基线和5年复查时对神经认知障碍进行评估和分类，包括：自我和信息报告的认知情况、功能参与情况和神经心理学测试成绩：结果：5 年随访时招募了 195 名患者和 21 名对照组参与者。在患者队列中，神经认知障碍的患病率为 38.1%（n = 75），其中 61 人（30.1%）符合轻度神经认知障碍的标准，14 人（7.1%）符合重度神经认知障碍的标准。在 5 年的随访中，121 例（61.4%）患者被归类为神经认知障碍，其中 88 例（44.7%）为轻度神经认知障碍，33 例（16.8%）为重度神经认知障碍。年龄（几率比（95%CI）1.07（1.02-1.13）；P = 0.01）和基线认知障碍（几率比（95%CI）2.1（1.06-4.15）；P = 0.03）是术后5年神经认知障碍的重要预测因素：结论：半数以上的老年患者在选择性骨科手术 5 年后出现某种形式的神经认知障碍。手术和麻醉可能与高危老年人（包括术前存在认知障碍的老年人）认知能力下降的轨迹有关。在对老年人进行术前评估时应考虑到认知筛查，以便为后续护理提供依据。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Anaesthesia 医学-麻醉学

CiteScore

21.20

自引率

9.30%

发文量

300

审稿时长

6 months

期刊介绍： The official journal of the Association of Anaesthetists is Anaesthesia. It is a comprehensive international publication that covers a wide range of topics. The journal focuses on general and regional anaesthesia, as well as intensive care and pain therapy. It includes original articles that have undergone peer review, covering all aspects of these fields, including research on equipment.