Outcomes associated with postoperative cognitive dysfunction: a systematic review and meta-analysis
Authors
Patumporn Suraarunsumrit , Varalak Srinonprasert , Tanawan Kongmalai , Surasit Suratewat , Usa Chaikledkaew , Sasivimol Rattanasiri , Gareth McKay , John Attia , Ammarin Thakkinstian
Background
Postoperative cognitive dysfunction (POCD) manifests as a subtle decline in cognition, potentially leading to unfavourable postoperative outcomes. We explored the impact of POCD on physical function, length of hospital stay (LOS), dementia and mortality outcomes.
Methods
PubMed and Scopus were searched until May 2023. All studies of major surgical patients that assessed POCD and outcomes of interest were included. POCD effects were stratified by surgery type (cardiac and noncardiac) and time of POCD assessment (<30 and ≥30 days postsurgery).
Results
Of 2316 studies, 20 met the inclusion criteria. POCD was not associated with functional decline postsurgery. Patients who experienced POCD postcardiac surgery had an increased relative risk (RR) of death of 2.04 [(95% CI: 1.18, 3.50); I2 = 0.00%]. Sensitivity analyses showed associations with intermediate-term mortality among noncardiac surgical patients, with an RR of 1.84 [(95% CI: 1.26, 2.71); I2 = 0.00%]. Patients who developed POCD <30 days postcardiac and noncardiac surgeries experienced longer LOS than those who did not [mean difference (MD) = 1.37 days (95% CI: 0.35, 2.39); I2 = 92.38% and MD = 1.94 days (95% CI: 0.48, 3.40); I2 = 83.29%, respectively]. Postoperative delirium (POD) may contribute to the heterogeneity observed, but limited data were reported within the studies included.
Conclusions
Patients undergoing cardiac and noncardiac surgeries who developed POCD <30 days postsurgery had poorer outcomes and an increased risk of premature death. Early recognition of perioperative neurocognitive disorders in at-risk patients may enable early intervention. However, POD may confound our findings, with further studies necessary to disentangle the effects of POD from POCD on clinical outcomes.
Keyword
postoperative cognitive dysfunction, major surgery, mortality, length of hospital stay, meta-analysis, systematic review, older people
Topic
length of stay, surgical procedures, postoperative cognitive dysfunction
Subject
Perioperative Care of Older People Undergoing Surgery Issue
Section
Systematic review
Age and Ageing, Volume 53, Issue 7, July 2024, afae160,
Oxford University Press
British Geriatrics Society (BGS)
Improving healthcare for older people
อ่านเพิ่มเติม
https://academic.oup.com/ageing/article/53/7/afae160/7721454