Recent advances and perspectives of postoperative neurological disorders in the elderly surgical patients

Abstract

Postoperative neurological disorders, including postoperative delirium (POD), postoperative cognitive dysfunction (POCD), postoperative covert ischemic stroke, and hemorrhagic stroke, are challenging clinical problems in the emerging aged surgical population. These disorders can deteriorate functional outcomes and long-term quality of life after surgery, resulting in a substantial social and financial burden to the family and society. Understanding predisposing and precipitating factors may promote individualized preventive treatment for each disorder, as several risk factors are modifiable. Besides prevention, timely identification and treatment of etiologies and symptoms can contribute to better recovery from postoperative neurological disorders and lower risk of long-term cognitive impairment, disability, and even death. Herein, we summarize the diagnosis, risk factors, prevention, and treatment of these postoperative complications, with emphasis on recent advances and perspectives.

Keywords: cognitive disorders; covert stroke; delirium; hemorrhagic stroke; postoperative neurological disorders; stroke.

FIGURE 1

Nonpharmacological and pharmacological interventions during preventive process of POD recommended in HELP and latest evidence‐based advance research on prevention of POD, including interventions throughout the whole process of surgery and possible medications for treatment that needed further research. POD, postoperative delirium; HELP, Hospital Elder Life Program

FIGURE 2

Preventive measures of POCD based on latest research on it during preoperative, intraoperative, and postoperative process and possible effective medications that may contribute to the prevention. POCD, postoperative cognitive dysfunction. BIS, bispectral index. COX‐2, cyclooxygenase‐2