Effect of goal-directed fluid therapy on early cognitive function in elderly patients with spinal stenosis: Case-control study

Abstract

Dear Editor, We read the article entitled: “Effect of goal-directed fluid therapy (GDFT) on early cognitive function in elderly patients with spinal stenosis: Case-Control Study” [1] with great interest. In this study, the authors concluded that GDFT could decrease the incidence of early postoperative cognitive dysfunction (POCD) of elderly patients with spinal stenosis by maintaining the stability of perioperative hemodynamics in the prone position, improving the balance between perfusion of tissue and organ, and supply and demand of oxygen, and reducing the inflammatory response. The efforts of the authors to investigate this important topic are appreciated. However, we would like to offer some comments to the authors. First, to avoid the influence of any factor on the main endpoint in this study, all possible influencing factors must be well controlled to avoid potential biases. There are a good deal of known risk factors associated with postoperative cognitive dysfunction in elderly patients undergoing orthopedic surgery. However, many of these factors were not discussed in this article, such as comorbid diseases, depression, depth of anesthesia and preoperative drug treatment. [2], which would have biased the results of this study. Second, many studies found that the incidence of postoperative cognitive dysfunction was increased in patients with a longer duration of anesthesia [3,4]. However, the authors did not assess whether there was a difference in the duration of anesthesia between the two groups in this paper, which affects the rigor of the conclusions. Lastly, previous studies have identified pain to be an independent risk factor for cognitive decline [5,6]. However, the authors did not assess the degree of postoperative pain and the specific dose of analgesics used in this study, except for the type of perioperative analgesics. Therefore, we believe that postoperative pain, such as the pain level and the doses of analgesics, may be confounding factors that can affect the accuracy of the results of this study. In conclusion, we hope the above questions that we have raised can draw the attention of the authors of this research and by so doing can improve the quality in their future studies. Provenance and peer review Commentary, internally reviewed. Ethical approval Not applicable. Sources of funding The work was supported by the Key Research and Development Program of Hebei Province (Grant No. 19277714D). Author contribution Tingting Jiang: Writing. Jianli Li: Conceptualization and Methodology. International journal of surgery author disclosure form The following additional information is required for submission. Please note that failure to respond to these questions/statements will mean your submission will be returned. If you have nothing to declare in any of these categories then this should be stated. Research registration unique identifying number (UIN) Not applicable. Guarantor Jianli Li. Declaration of competing interest No conflict of interest associated with this work. Tingting Jiang Jianli Li 1Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, 050051, Hebei Province, China 2Graduate Faculty, Hebei North University, Zhangjiakou, 075000, Hebei Province, China E-mail addresses:[email protected]