S Paredes1, L Cortínez1, V Contreras1, B Silbert2,3. 1. Anesthesiology Division, Pontificia Universidad Catolica de Chile, Santiago, Chile. 2. Centre for Anaesthesia and Cognitive Function, Department of Anaesthesia, St Vincent's Hospital, Melbourne, Fitzroy, Vic., Australia. 3. Anaesthesia, Perioperative and Pain Medicine Unit, Melbourne Medical School, University of Melbourne, Melbourne, Vic., Australia.
Abstract
BACKGROUND: Post-operative cognitive dysfunction is defined as a decline in cognitive functions that occurs after surgery, but different diagnostic criteria and incidences have been reported in medical literature. Our aim was to determine incidence of post-operative cognitive dysfunction 3 months after non-cardiac surgery in adults. METHODS: A systematic review of available evidence was performed by PRISMA guidelines. A search was done in May-July 2015 on PubMed, EMBASE, CINAHL, LILACS, Scielo, Clinical Trials, and Grey Literature Reports. Inclusion criteria were prospective design studies with patients over 18 years old, surgery under general or regional anesthesia, follow-up for 3 months, and use of a neurocognitive battery for diagnosis. We excluded studies made on cardiac or brain surgery patients. Risk of bias was assessed using tools from National Heart Lung and Blood Institute. RESULTS: We selected 24 studies. Average age was 68 years. Only five studies reported incidence of cognitive decline for a non-surgical control group. Median number of tests used was 5 (range 3-13). Pooled incidence of post-operative cognitive dysfunction at 3 months was 11.7% [95% CI 10.9-12.5] but with several methodological differences between studies. Increasing age was the most consistent risk factor identified (seven studies). CONCLUSIONS: Post-operative cognitive dysfunction in patients is frequent, especially in patients over 60 years old. Limitations include methodological differences in studies. Efforts must be made to reach a consensus in definition and diagnosis for future research.
BACKGROUND: Post-operative cognitive dysfunction is defined as a decline in cognitive functions that occurs after surgery, but different diagnostic criteria and incidences have been reported in medical literature. Our aim was to determine incidence of post-operative cognitive dysfunction 3 months after non-cardiac surgery in adults. METHODS: A systematic review of available evidence was performed by PRISMA guidelines. A search was done in May-July 2015 on PubMed, EMBASE, CINAHL, LILACS, Scielo, Clinical Trials, and Grey Literature Reports. Inclusion criteria were prospective design studies with patients over 18 years old, surgery under general or regional anesthesia, follow-up for 3 months, and use of a neurocognitive battery for diagnosis. We excluded studies made on cardiac or brain surgery patients. Risk of bias was assessed using tools from National Heart Lung and Blood Institute. RESULTS: We selected 24 studies. Average age was 68 years. Only five studies reported incidence of cognitive decline for a non-surgical control group. Median number of tests used was 5 (range 3-13). Pooled incidence of post-operative cognitive dysfunction at 3 months was 11.7% [95% CI 10.9-12.5] but with several methodological differences between studies. Increasing age was the most consistent risk factor identified (seven studies). CONCLUSIONS: Post-operative cognitive dysfunction in patients is frequent, especially in patients over 60 years old. Limitations include methodological differences in studies. Efforts must be made to reach a consensus in definition and diagnosis for future research.
Authors: Lori A Daiello; Annie M Racine; Ray Yun Gou; Edward R Marcantonio; Zhongcong Xie; Lisa J Kunze; Kamen V Vlassakov; Sharon K Inouye; Richard N Jones; David Alsop; Thomas Travison; Steven Arnold; Zara Cooper; Bradford Dickerson; Tamara Fong; Eran Metzger; Alvaro Pascual-Leone; Eva M Schmitt; Mouhsin Shafi; Michele Cavallari; Weiying Dai; Simon T Dillon; Janet McElhaney; Charles Guttmann; Tammy Hshieh; George Kuchel; Towia Libermann; Long Ngo; Daniel Press; Jane Saczynski; Sarinnapha Vasunilashorn; Margaret O'Connor; Eyal Kimchi; Jason Strauss; Bonnie Wong; Michael Belkin; Douglas Ayres; Mark Callery; Frank Pomposelli; John Wright; Marc Schermerhorn; Tatiana Abrantes; Asha Albuquerque; Sylvie Bertrand; Amanda Brown; Amy Callahan; Madeline D'Aquila; Sarah Dowal; Meaghan Fox; Jacqueline Gallagher; Rebecca Anna Gersten; Ariel Hodara; Ben Helfand; Jennifer Inloes; Jennifer Kettell; Aleksandra Kuczmarska; Jacqueline Nee; Emese Nemeth; Lisa Ochsner; Kerry Palihnich; Katelyn Parisi; Margaret Puelle; Sarah Rastegar; Margaret Vella; Guoquan Xu; Margaret Bryan; Jamey Guess; Dee Enghorn; Alden Gross; Yun Gou; Daniel Habtemariam; Ilean Isaza; Cyrus Kosar; Christopher Rockett; Douglas Tommet; Ted Gruen; Meg Ross; Katherine Tasker; James Gee; Ann Kolanowski; Margaret Pisani; Sophia de Rooij; Selwyn Rogers; Stephanie Studenski; Yaakov Stern; Anthony Whittemore; Gary Gottlieb; John Orav; Reisa Sperling Journal: Anesthesiology Date: 2019-09 Impact factor: 7.892
Authors: Miles Berger; Niccolò Terrando; S Kendall Smith; Jeffrey N Browndyke; Mark F Newman; Joseph P Mathew Journal: Anesthesiology Date: 2018-10 Impact factor: 7.892