Association between anaesthesia-related factors and postoperative neurocognitive disorder: a post-hoc analysis

Manon Stern; Gertrude J Nieuwenhuijs-Moeke; Anthony Absalom; Barbara van Leeuwen; Hanneke van der Wal-Huisman; Matthijs Plas; Dirk J Bosch

doi:10.1186/s12871-023-02318-3

Association between anaesthesia-related factors and postoperative neurocognitive disorder: a post-hoc analysis

BMC Anesthesiol. 2023 Nov 10;23(1):368. doi: 10.1186/s12871-023-02318-3.

Authors

Manon Stern¹, Gertrude J Nieuwenhuijs-Moeke¹, Anthony Absalom¹, Barbara van Leeuwen², Hanneke van der Wal-Huisman², Matthijs Plas³, Dirk J Bosch⁴

Affiliations

¹ Department of Anesthesiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
² Department of Surgery/ Surgical Oncology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
³ Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
⁴ Department of Anesthesiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands. d.j.bosch@umcg.nl.

Abstract

Background: Postoperative neurocognitive disorder (pNCD) is common after surgery. Exposure to anaesthetic drugs has been implicated as a potential cause of pNCD. Although several studies have investigated risk factors for the development of cognitive impairment in the early postoperative phase, risk factors for pNCD at 3 months have been less well studied. The aim of this study was to identify potential anaesthesia-related risk factors for pNCD at 3 months after surgery.

Methods: We analysed data obtained for a prospective observational study in patients aged ≥ 65 years who underwent surgery for excision of a solid tumour. Cognitive function was assessed preoperatively and at 3 months postoperatively using 5 neuropsychological tests. Postoperative NCD was defined as a postoperative decline of ≥ 25% relative to baseline in ≥ 2 tests. The association between anaesthesia-related factors (type of anaesthesia, duration of anaesthesia, agents used for induction and maintenance of anaesthesia and analgesia, the use of additional vasoactive medication, depth of anaesthesia [bispectral index] and mean arterial pressure) and pNCD was analysed using logistic regression analyses. Furthermore, the relation between anaesthesia-related factors and change in cognitive test scores expressed as a continuous variable was analysed using a z-score.

Results: Of the 196 included patients, 23 (12%) fulfilled the criteria for pNCD at 3 months postoperatively. A low preoperative score on Mini-Mental State Examination (OR, 8.9 [95% CI, (2.8-27.9)], p < 0.001) and a longer duration of anaesthesia (OR, 1.003 [95% CI, (1.001-1.005)], p = 0.013) were identified as risk factors for pNCD. On average, patients scored higher on postoperative tests (mean z-score 2.35[± 3.13]).

Conclusion: In this cohort, duration of anaesthesia, which is probably an expression of the complexity of the surgery, was the only anaesthesia-related predictor of pNCD. On average, patients' scores on cognitive tests improved postoperatively.

Keywords: Anaesthesia; Postoperative cognitive dysfunction (POCD); Postoperative complications; Postoperative neurocognitive disorder (pNCD).

Publication types

Observational Study
Research Support, Non-U.S. Gov't

MeSH terms

Anesthesia* / adverse effects
Cognitive Dysfunction* / chemically induced
Cognitive Dysfunction* / diagnosis
Cognitive Dysfunction* / epidemiology
Humans
Neurocognitive Disorders / etiology
Neuropsychological Tests
Postoperative Complications / etiology