Preoperative Chronic Pain as a Risk Factor for Early Postoperative Cognitive Dysfunction in Elderly Patients Undergoing Hip Joint Replacement Surgery: A Prospective Observational Cohort Study.

Xiaorong Huai,Huichen Zhu,Hong Xie,Weifeng Yu,Xiyao Gu,Lingke Chen,Yingfu Jiao,Yichen Fan,Diansan Su

doi:10.3389/fnins.2021.747362

Abstract

Background: Although major joint replacement surgery has a high overall success rate, postoperative cognitive dysfunction (POCD) is a common complication after anesthesia and surgery, increasing morbidity and mortality. Identifying POCD risk factors would be helpful to prevent and decrease the occurrence of POCD. We hypothesized that preoperative chronic pain increases the risk of POCD.Methods: A single-center, observational, prospective cohort study was conducted from January 2018 to March 2020. All consecutive elderly patients (>65 years) who underwent elective total hip arthroplasty or hemiarthroplasty with general anesthesia by the same surgeon were enrolled. The patients underwent neuropsychological testing preoperatively and at 7 days and 2 months after surgery. To determine POCD, a nonsurgical control group was recruited from the general community.Results: Of the 141 patients who finished the neuropsychological testing 7 days after surgery, 61 (43.2%) had preoperative chronic pain. Of the 61 patients, 17 (27.9%) developed POCD; of the 79 patients with no chronic pain, 10 (12.7%) had developed POCD by 7 days after surgery. Multivariate logistic regression analysis identified preoperative chronic pain as a risk factor of POCD assessed 7 days after surgery (odds ratio 6.527; P = 0.009). There was no significant difference in the POCD incidence 2 months after surgery between patients with and without preoperative chronic pain.Conclusion: Preoperative chronic pain was a risk factor of developing POCD within 7 days after surgery in elderly patients following hip joint replacement surgery.Clinical Trial Registration: [www.ClinicalTrials.gov], identifier [NCT03393676].

Highlights

Major joint replacement surgery is one of the most common elective procedures and is performed primarily in elderly adults
There was no significant difference in the postoperative cognitive dysfunction (POCD) incidence 2 months after surgery between patients with and without preoperative chronic pain
Despite the overall success of major joint replacement surgery, patients undergoing this surgical procedure still remain susceptible to cognitive decline, termed POCD, reported rates of which varied between 7% and 75% depending on the definition, assessment tools used, and the population being studied (Deo et al, 2011; Postler et al, 2011)

Summary

Introduction

Major joint replacement surgery is one of the most common elective procedures and is performed primarily in elderly adults. Several factors have been shown to be risk factors of POCD after hip and knee surgery, including the effects of anesthetics (Duggleby and Lander, 1994; Zywiel et al, 2014), increased age, fewer formal education years or lower reading level, cerebral microemboli caused by fat or marrow entering the blood during surgery (Patel et al, 2010), lower preoperative brain integrity, and lower preoperative executive and memory functions (Monk et al, 2008; Greene et al, 2009; Smith et al, 2009; Price et al, 2014, 2017; Saczynski et al, 2014; Shioiri et al, 2016) It is unclear if preoperative pain, which is one of the main reasons of major joint replacement surgery, is a risk factor of POCD. We hypothesized that preoperative chronic pain increases the risk of POCD

Methods

Results

Conclusion