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. 2021 Feb;32(2):433-442.
doi: 10.1007/s00192-020-04495-y. Epub 2020 Aug 22.

Incidence of postoperative cognitive dysfunction in older women undergoing pelvic organ prolapse surgery

Mary F Ackenbom  1   2 , Meryl A Butters  3 , Esa M Davis  4 , Kaleab Z Abebe  4   5 , Lindsey Baranski  2 , Halina M Zyczynski  1   2
Affiliations

Incidence of postoperative cognitive dysfunction in older women undergoing pelvic organ prolapse surgery

Mary F Ackenbom et al. Int Urogynecol J. 2021 Feb.

Abstract

Introduction and hypothesis: Postoperative cognitive dysfunction (POCD), a transient impairment of memory, concentration, and information processing, has been reported after 7-26% of non-cardiac surgeries with associated increase in morbidity and death. Our primary aim was to determine the incidence of POCD 2 weeks after prolapse surgery in women ≥ 60 years old. Our secondary aim was to identify risk factors for POCD.

Methods: Prospective cohort study of women ≥ 60 years old scheduled for pelvic organ prolapse surgery. Exclusion criteria included cognitive impairment history, major neurologic disorder, and abnormal cognition screen. A comprehensive neuropsychologic (NP) battery (eight tests), administered 2 weeks pre- and post-surgery, assessed premorbid IQ and domains of attention, memory, and executive function. The primary outcome was defined as decline of ≥ 1 SD on ≥ 2 NP tests or decline of ≥ 2 SD on ≥ 1 test. Raw scores were transformed to Z-scores.

Results: NP testing was completed by 72 women, median age 72 (IQR 69-77) years. Procedures included 16 (22.9%) laparoscopic sacrocolpopexies, 23 (32.9%) transvaginal reconstructions, and 29 (41.4%) obliterative surgeries, performed under general (63, 90%), regional (5, 7.1%), or sedation (2, 2.9%) anesthesia with a median hospital stay of 0.6 (IQR 0.6-0.75) days. POCD incidence was 33.3% (n = 24). POCD was associated with greater frailty (p = 0.006) and higher baseline depression (p = 0.05) but not with older age (p = 0.77) or inhalational gas use (p = 1.0).

Conclusion: In this cohort, one in three women manifested POCD 2 weeks after prolapse surgery. Preoperative counseling should include discussions on POCD given its detrimental impact on postoperative recovery and independence.

Keywords: Cognitive decline; Older women; Pelvic organ prolapse surgery; Perioperative neurocognitive disorders; Postoperative cognitive dysfunction; Urogynecologic surgery.

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Figures

Figure 1.
Figure 1.
Flow diagram of study participants
Figure 2.
Figure 2.
Cognitive Testing Changes by Domain and Participant
See this image and copyright information in PMC

References

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