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.
Section of Surgical Pathophysiology, University of Copenhagen, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark.
J Clin Anesth. 2019 Nov;57:80-86. doi: 10.1016/j.jclinane.2019.03.021. Epub 2019 Mar 28.
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.
A subanalysis of a prospective study.
Hospital ward, patients own home.
One-hundred-and-four patients undergoing elective THA/TKA.
A full contextual and validated cognitive test battery pre- and 2-3 weeks postoperatively by interview by research nurse.
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.
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.
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.
非快速通道手术后，术后认知功能障碍（POCD）仍然是一种常见的术后并发症，对恢复日常活动和工作有负面影响。在快速通道全髋关节和膝关节置换术（THA/TKA）中，术后 3 个月时 POCD 的发生率为 8-9%，但没有详细说明具体的围手术期危险因素。因此，我们在一个精心控制的患者队列中重新研究了 POCD 的发生率和建议因素的作用，以指导未来的预防干预措施。
一项前瞻性研究的亚分析。
医院病房，患者自己的家。
104 例行择期 THA/TKA 的患者。
由研究护士通过访谈，在术前和术后 2-3 周对患者进行全面的、经过验证的认知测试。
通过与未接受手术的年龄匹配的对照组的正常数据，对认知测试结果进行校正，以纠正学习效果。通过单变量和多变量逻辑分析，研究与 POCD 相关的潜在围手术期危险因素（年龄、手术、性别、炎症、血百分比、阿片类药物等），并设定 5%的显著性水平。
4 名患者（3.9%）发生 POCD。POCD 阳性患者在急性术后期间（术后第 0-3 天：中位数 214mg）消耗的阿片类药物剂量高于 POCD 阴性患者（术后第 0-3 天：中位数 98mg，p=0.008），并且在 2-3 周的研究期间也是如此（POCD 阳性 vs. POCD 阴性患者，中位数分别为 739mg 和 208mg）。其他术前和术后因素无显著差异，但与 POCD 的发生有关。
快速通道 THA/TKA 患者 POCD 发生率较低，可能与术后阿片类药物消耗有关，这支持了对阿片类药物节约性镇痛的持续关注。
