Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2015 Jan-Mar;31(1):30-6.
doi: 10.4103/0970-9185.150530.

Incidence and risk factors for postoperative cognitive dysfunction in older adults undergoing major noncardiac surgery: A prospective study

Osama A Shoair  1 , Mario P Grasso Ii  2 , Laura A Lahaye  3 , Ronsard Daniel  3 , Chuck J Biddle  2 , Patricia W Slattum  1
Affiliations

Incidence and risk factors for postoperative cognitive dysfunction in older adults undergoing major noncardiac surgery: A prospective study

Osama A Shoair et al. J Anaesthesiol Clin Pharmacol. 2015 Jan-Mar.

Abstract

Background & aims: Postoperative cognitive dysfunction (POCD) is a decline in cognitive function that occurs after surgery. The purpose of this study was to estimate the incidence and identify potential risk factors of POCD in older adults undergoing major noncardiac surgery.

Materials and methods: A total of 69 patients aged 65 years or older undergoing major noncardiac surgery were enrolled. Patients' cognitive function was assessed before and 3 months after surgery using a computerized neurocognitive battery. A nonsurgical control group of 54 older adults was recruited to adjust for learning effects from repeated administration of neurocognitive tests. Data about potential risk factors for POCD were collected before, during, and after surgery, including patient, medication, and surgery factors. The incidence of POCD was calculated using the Z-score method. A multivariable logistic regression model was used to identify risk factors for POCD.

Results: POCD was present in eleven patients (15.9%, 95% confidence interval [CI] = 7.3-24.6) 3 months after major noncardiac surgery. Carrying the apolipoprotein E4 (APOE4) genotype (odds ratio [OR] = 4.74, 95% CI = 1.09-22.19), using one or more highly anticholinergic or sedative-hypnotic drugs at home prior to surgery (OR = 5.64, 95% CI = 1.35-30.22), and receiving sevoflurane for anesthesia (OR = 6.43, 95% CI = 1.49-34.66) were associated with the development of POCD.

Conclusions: POCD was observed in 15.9% of older adults after major noncardiac surgery. Risk factors for POCD in these patients were carrying the APOE4 genotype, using one or more highly anticholinergic or sedative-hypnotic drugs prior to surgery, and receiving sevoflurane for anesthesia.

Keywords: Cognitive; dysfunction; noncardiac; older; postoperative; surgery.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest: None declared.

Figures

Figure 1
Figure 1
Recruitment process for study surgical patients
Figure 2
Figure 2
Recruitment process for study nonsurgical controls
See this image and copyright information in PMC

References

    1. Mangoni AA, Jackson SH. Age-related changes in pharmacokinetics and pharmacodynamics: Basic principles and practical applications. Br J Clin Pharmacol. 2004;57:6–14. - PMC - PubMed
    1. Lewis MC, Nevo I, Paniagua MA, Ben-Ari A, Pretto E, Eisdorfer S, et al. Uncomplicated general anesthesia in the elderly results in cognitive decline: Does cognitive decline predict morbidity and mortality? Med Hypotheses. 2007;68:484–92. - PubMed
    1. Pieperhoff P, Hömke L, Schneider F, Habel U, Shah NJ, Zilles K, et al. Deformation field morphometry reveals age-related structural differences between the brains of adults up to 51 years. J Neurosci. 2008;28:828–42. - PMC - PubMed
    1. Bell JS, Mezrani C, Blacker N, LeBlanc T, Frank O, Alderman CP, et al. Anticholinergic and sedative medicines — Prescribing considerations for people with dementia. Aust Fam Physician. 2012;41:45–9. - PubMed
    1. Steinmetz J, Christensen KB, Lund T, Lohse N, Rasmussen LS ISPOCD Group. Long-term consequences of postoperative cognitive dysfunction. Anesthesiology. 2009;110:548–55. - PubMed