Hussein Nasser Awada1, Iben Engelund Luna2, Henrik Kehlet3, Heidi Raahauge Wede4, Susanne Jung Hoevsgaard5, Eske Kvanner Aasvang6. 1. Section of Surgical Pathophysiology, University of Copenhagen, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark; Anesthesiological Department, The Abdominal Centre, University of Copenhagen, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark. Electronic address: hussein.nasser.awada@regionh.dk. 2. Section of Surgical Pathophysiology, University of Copenhagen, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark. 3. Section of Surgical Pathophysiology, University of Copenhagen, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark; The Lundbeck Centre for Fast-track Hip and Knee Arthroplasty, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark. 4. Department of Orthopedics, Gentofte-Herlev Hospital, University of Copenhagen, Kildegårdsvej 28, 2900 Hellerup, Denmark. 5. Department of Orthopedics, Vejle Hospital, Beriderbakken 4, 7100 Vejle, Denmark. 6. Section of Surgical Pathophysiology, University of Copenhagen, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark; Anesthesiological Department, The Abdominal Centre, University of Copenhagen, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark.
Abstract
STUDY OBJECTIVE: Postoperative cognitive dysfunction (POCD) remains a frequent postoperative complication in non-fast-track surgeries, with negative implications for return to daily activities and work. In fast-track total hip and -knee arthroplasty (THA/TKA) an 8-9% incidence of POCD after 3 months has been reported, but without details on specific perioperative risk factors. Thus, we re-investigated the incidence and role of suggested factors for POCD in a well-controlled patient cohort, to guide future preventive interventions. DESIGN: A subanalysis of a prospective study. SETTING: Hospital ward, patients own home. PATIENTS: One-hundred-and-four patients undergoing elective THA/TKA. INTERVENTIONS: A full contextual and validated cognitive test battery pre- and 2-3 weeks postoperatively by interview by research nurse. MEASUREMENTS: Results from the cognitive test battery were corrected for learning effect by normative data from an age-matched unoperated control group. Potential perioperative risk factors (age, procedure, gender, inflammation, blood-percentage, opioids etc.) associated with POCD was investigated by univariate and multivariate logistic analysis, with a 5% significance level. MAIN RESULTS: Four patients (3.9%) developed POCD. POCD-positive patients consumed higher dose of opioids in the acute postoperative period (postoperative days 0-3: median 214 mg), vs. POCD-negative patients (postoperative days 0-3: median 98 mg, p = 0.008), and during the 2-3-week study period (POCD-positive vs. POCD-negative patients, median 739 mg vs. 208 mg, respectively). Other pre and postoperative factors were non-significant but associated with the development of POCD. CONCLUSION: POCD is rare in fast-track THA/TKA patients and may be related to postoperative opioid consumption, supporting the ongoing focus on opioid-sparing analgesia.
STUDY OBJECTIVE:Postoperative cognitive dysfunction (POCD) remains a frequent postoperative complication in non-fast-track surgeries, with negative implications for return to daily activities and work. In fast-track total hip and -knee arthroplasty (THA/TKA) an 8-9% incidence of POCD after 3 months has been reported, but without details on specific perioperative risk factors. Thus, we re-investigated the incidence and role of suggested factors for POCD in a well-controlled patient cohort, to guide future preventive interventions. DESIGN: A subanalysis of a prospective study. SETTING: Hospital ward, patients own home. PATIENTS: One-hundred-and-four patients undergoing elective THA/TKA. INTERVENTIONS: A full contextual and validated cognitive test battery pre- and 2-3 weeks postoperatively by interview by research nurse. MEASUREMENTS: Results from the cognitive test battery were corrected for learning effect by normative data from an age-matched unoperated control group. Potential perioperative risk factors (age, procedure, gender, inflammation, blood-percentage, opioids etc.) associated with POCD was investigated by univariate and multivariate logistic analysis, with a 5% significance level. MAIN RESULTS: Four patients (3.9%) developed POCD. POCD-positive patients consumed higher dose of opioids in the acute postoperative period (postoperative days 0-3: median 214 mg), vs. POCD-negative patients (postoperative days 0-3: median 98 mg, p = 0.008), and during the 2-3-week study period (POCD-positive vs. POCD-negative patients, median 739 mg vs. 208 mg, respectively). Other pre and postoperative factors were non-significant but associated with the development of POCD. CONCLUSION:POCD is rare in fast-track THA/TKA patients and may be related to postoperative opioid consumption, supporting the ongoing focus on opioid-sparing analgesia.
Authors: Mark C Kendall; Lucas J Alves; Kristi Pence; Taif Mukhdomi; Daniel Croxford; Gildasio S De Oliveira Journal: Anesthesiol Res Pract Date: 2020-03-27