Abstract
The incidence of dementia in patients with surgery under neuraxial anesthesia and the possibility of surgery under neuraxial anesthesia as a risk factor for dementia were investigated. We performed a retrospective matched cohort study with nationwide, representative cohort sample data of the Korean National Health Insurance Service in South Korea between 1 January 2003, and 31 December 2004. The participants were divided into control (n = 4488) and neuraxial groups (n = 1122) using propensity score matching. After 9 years of follow-up, the corresponding incidences of dementia were 11.5 and 14.8 cases per 1000 person-years. The risk of dementia in the surgery under neuraxial group was 1.44-fold higher (95% confidence interval [95%CI], 1.17–1.76) than that in the control group. In the subgroup analysis of dementia, the risk of Alzheimer’s disease in those who underwent surgery under neuraxial anesthesia was 1.48-fold higher (95%CI, 1.17–1.87) than that in those who did not undergo surgery under anesthesia. Our findings suggest that patients who underwent surgery under neuraxial anesthesia had a higher risk of dementia and Alzheimer’s disease than those who did not undergo surgery under neuraxial anesthesia.
Highlights
Neuraxial anesthesia techniques include spinal, epidural, and combined spinalepidural anesthesia
We aimed to evaluate the incidence of dementia in patients who underwent surgery under neuraxial anesthesia and investigate the potential of surgery under neuraxial anesthesia as a risk factor for dementia using nationwide, representative cohort sample data
The overall incidence of dementia was higher in the surgery under neuraxial anesthesia group (14.8 per 1000 person-years) than in the comparison group (11.5 per 1000 person-years) (Table 2)
Summary
Neuraxial anesthesia techniques include spinal, epidural, and combined spinalepidural anesthesia. Previous observational and randomized studies have suggested that surgery under neuraxial anesthesia is associated with better results than surgery under general anesthesia for some procedures, it lacked high-quality evidence [2] and did not have more significant advantages over other specific types of anesthesia [3,4]. There is a perception that postoperative cognitive decline may increase the risk of dementia and Alzheimer’s disease [9]; some patients prefer surgery under neuraxial anesthesia to general anesthesia. Neuraxial anesthesia may expose patients to a certain degree of postoperative cognitive decline and dementia. We aimed to evaluate the incidence of dementia in patients who underwent surgery under neuraxial anesthesia and investigate the potential of surgery under neuraxial anesthesia as a risk factor for dementia using nationwide, representative cohort sample data
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