Risk factors and predictive value of perioperative neurocognitive disorders in elderly patients with gastrointestinal tumors

BMC Anesthesiol. 2021 Jul 19;21(1):193. doi: 10.1186/s12871-021-01405-7.

Abstract

Background: This study aims to investigate the risk factors of perioperative neurocognitive disorders (PNDs) mainly including postoperative cognitive dysfunction (POCD) in elderly patients with gastrointestinal tumors, and evaluate its predictive value.

Methods: A total of 222 eligible elderly patients (≥65 years) scheduled for elective gastroenterectomy under general anesthesia were enrolled. The cognitive function assessment was carried out 1 day before surgery and 7 days after surgery. Receiver operating characteristic curve analysis was performed to evaluate the predictive value of risk factors for early POCD. The risk factors for POCD were analyzed using univariate and multivariate logistic regression model.

Results: Of all the 222 enrolled patients, 91 (41.0%) developed early POCD and 40 (18.0%) were identified as major POCD within 7 days after the surgery. Visual analogue score (VAS, 1st day, resting) ≥4 (OR = 7.618[3.231-17.962], P < 0.001) and alcohol exposure (OR = 2.398[1.174-4.900], P = 0.016) were independent risk factors for early POCD. VAS score (1st, resting) ≥4 (OR = 13.823[4.779-39.981], P < 0.001), preoperative white blood cell (WBC) levels ≥10 × 10*9/L (OR = 5.548[1.128-26.221], P = 0.035), blood loss ≥500 ml (OR = 3.317[1.094-10.059], P = 0.034), history of hypertension (OR = 3.046[1.267-7.322], P = 0.013), and neutrophil-lymphocyte ratio (NLR) ≥2 (OR = 3.261[1.020-10.419], P = 0.046) were independent risk factors for major POCD. Receiver operating characteristic curve analysis indicated that VAS score (1st day, resting) was a significant predictor for major POCD with a cut-off value of 2.68 and an area under the curve of 0.860 (95% confidence interval: 0.801-0.920, P < 0.001).

Conclusions: The risk factors for early POCD after gastroenterectomy included high VAS score (1st day, resting) and alcohol exposure. High VAS score, preoperative WBC levels ≥10 × 10*9/L, blood loss ≥500 ml, NLR ≥2, and history of hypertension were independent risk factors for major POCD. Among them, VAS score was one of the important predictors.

Keywords: Elderly; Gastrointestinal tumors; Perioperative neurocognitive disorders; Postoperative cognitive dysfunction; Risk factors.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Anesthesia, General / methods
  • Digestive System Surgical Procedures / methods*
  • Female
  • Gastrectomy / methods
  • Gastrointestinal Neoplasms / surgery*
  • Humans
  • Hypertension / epidemiology
  • Male
  • Neurocognitive Disorders / epidemiology*
  • Neurocognitive Disorders / etiology
  • Postoperative Cognitive Complications / epidemiology*
  • Predictive Value of Tests
  • Retrospective Studies
  • Risk Factors