The anesthetic surgical act increases cognitive decline in older patients compared to a healthy population

Abstract

Background and Objective: The purpose of this study was to investigate whether anesthetic surgical act is a risk factor that contributes to the development of postoperative cognitive dysfunction (POCD) in elderly patients, or whether there are pre-existing conditions that predispose it. Materials and Methods: The study involved a non-randomized prospective cohort of patients over 65 years of age undergoing surgery/anes- thesia (as well as a group of healthy individuals who were not exposed to either anesthesia or surgery). The study was carried out at the Hospital Italiano Buenos Aires between April 2017 and March 2020, and the data was collected in the anesthesia service. A total of 200 participants were evaluated, 100 in each group. A battery of cognitive tests was administered at baseline and 12 months later. Cognitive impairment was assessed with scales and analyzed by multivariate and principal component analysis. Results: At 12 months, exposed patients had a 36% incidence of deterioration, while unexposed patients had only 8%. The odds ratio was 6.5 (95% CI 2.9-15.8 p < 0.001). Adjusting for increased to 8.6 (95% CI 3.6-22.9 p < 0.001). Main components were identified that were correlated with the cognitive scales. The crude relative risk derived from the odds ratio was 4.5, while the adjusted relative risk was 7.3. Conclusions: The findings validate the existence of durable cognitive performance results in patients who were exposed. It is essential to stress the importance of performing a cognitive assessment before administering anesthesia and/or surgery to identify vulnerable people and continue monitoring their evolution.