Abstract
BackgroundDelayed neurocognitive recovery (DNCR) is a common and serious complication after radical prostatectomy. We hypothesized that patients with DNCR in the early postoperative period would report reduced health-related quality of life (HRQoL) and more cognitive failures 12 months after surgery, compared with patients without DNCR.MethodsWe performed a 12-month follow-up on 367 patients who had been enrolled in a prospective observational trial to study the incidence of DNCR after radical prostatectomy. Patients were screened for preoperative cognitive impairment and depression. We defined DNCR as a decline in cognitive function between days 3 and 5 after surgery, compared with baseline assessments. We evaluated HRQoL and cognitive failures 12 months after surgery with the 36-item Short Form Health Survey and the Cognitive Failures Questionnaire. General linear models were used to analyze associations of DNCR with HRQoL and cognitive failures.ResultsDelayed neurocognitive recovery in the early postoperative period was significantly associated with self-reported cognitive failures (B for no DNCR = − 0.411 [95% CI: − 0.798;0.024], p = 0.038), but not with physical (B = 0.082 [95% CI: − 0.021;0.186], p = 0.118) or mental HRQoL (B = − 0.044 [95% CI: − 0.149;0.062], p = 0.417) 12 months after surgery. Preoperative depression screening scores were significantly associated with self-reported cognitive failures and both physical and mental HRQoL 12 months after surgery.ConclusionsDelayed neurocognitive recovery in the early period after radical prostatectomy has a long-term impact on patients’ daily lives by impairing memory, attention, action, and perception. Therefore, prevention of DNCR must be a priority for physicians and researchers. Consequent preoperative screening for depressive symptoms may facilitate early psycho-oncological intervention to improve postoperative HRQoL.Trials registrationDRKS00010014, date of registration: 21.03.2016, retrospectively registered.
Highlights
Delayed neurocognitive recovery (DNCR) is a common and serious complication after radical prostatectomy
As surgical techniques have advanced in recent years, radical prostatectomy, especially robotassisted surgery, has become increasingly popular with patients and physicians In the majority of patients, radical prostatectomy is characterized by a low complication rate and a beneficial functional urological outcome [3]
Little is known about the longterm impact of DNCR on health-related quality of life (HRQoL) and cognitive function
Summary
Delayed neurocognitive recovery (DNCR) is a common and serious complication after radical prostatectomy. We hypothesized that patients with DNCR in the early postoperative period would report reduced healthrelated quality of life (HRQoL) and more cognitive failures 12 months after surgery, compared with patients without DNCR. Patients can expect to have excellent quality of life after radical prostatectomy [4]. Delayed neurocognitive recovery (DNCR)— formerly postoperative cognitive dysfunction—is a common complication during the early postoperative period after radical prostatectomy [5]. Some authors have reported cognitive function after 12 months to be similar to that of the general population, while other studies have not found a higher prevalence of cognitive impairment one year after non-cardiac surgery [10,11,12]. As the aim of modern medicine is to extend life expectancy and to improve quality of life, exploring the long-term consequences of DNCR may be crucial for optimizing postoperative HRQoL and cognitive performance [14]
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