Chicago Medical School, Rosalind Franklin University of Medicine and Science, Chicago, IL, USA.
Philip R. Lee Institute for Health Policy Studies, San Francisco, CA, USA.
Br J Anaesth. 2023 May;130(5):567-572. doi: 10.1016/j.bja.2023.02.003. Epub 2023 Mar 1.
Postoperative cognitive dysfunction (POCD) is a concern after anaesthesia and surgery, but preoperative discussion of neurocognitive risks with older patients rarely occurs. Anecdotal experiences of POCD are common in the popular media and may inform patient perspectives. However, the degree of alignment between lay and scientific perspectives on POCD is not known.
We performed inductive qualitative thematic analysis on website user comments publicly submitted under an article entitled, 'The hidden long-term risks of surgery: "It gives people's brains a hard time"', published by the UK-based news source The Guardian in April 2022.
We analysed 84 comments from 67 unique users. Themes that emerged from user comments included the importance of functional impact ('Couldn't work … even reading was a struggle'), attribution to a range of causes but particularly the use of general, rather than consciousness-preserving, anaesthesia techniques ('side effects aren't fully understood'), and inadequate preparation and response by healthcare providers ('I would have benefited by being warned').
There is misalignment between professional and lay understandings of POCD. Lay people emphasise subjective and functional impact of symptoms, and express beliefs about the role of anaesthetics in causing POCD. Some patients and caregivers affected by POCD report feeling abandoned by medical providers. In 2018, new nomenclature for postoperative neurocognitive disorders was published, which better aligns with lay perspectives by including subjective complaints and functional decline. Further studies based on newer definitions and public messaging may improve concordance between different understandings of this postoperative syndrome.
术后认知功能障碍（POCD）是麻醉和手术后的一个关注点，但很少有医生与老年患者术前讨论神经认知风险。POCD 的轶事在大众媒体中很常见，可能会影响患者的观点。然而，尚不清楚外行和科学观点在 POCD 方面的一致性程度。
我们对英国新闻媒体《卫报》于 2022 年 4 月发表的一篇题为《手术的长期隐性风险：“它让人大脑受苦”》的文章下公开提交的用户评论进行了归纳定性主题分析。
我们分析了 67 位用户的 84 条评论。用户评论中出现的主题包括功能影响的重要性（“无法工作……甚至阅读都很困难”）、归因于一系列原因，但特别是使用一般而非意识保存的麻醉技术（“副作用尚未完全了解”），以及医疗保健提供者的准备和反应不足（“如果有人警告我，我会受益的”）。
专业人士和外行对 POCD 的理解存在错位。外行强调症状的主观和功能影响，并表达了关于麻醉在引起 POCD 中的作用的信念。一些受 POCD 影响的患者和护理人员感到被医疗服务提供者抛弃。2018 年，发布了术后神经认知障碍的新命名法，通过纳入主观抱怨和功能下降，更好地与外行观点保持一致。基于新定义和公众信息的进一步研究可能会提高对这种术后综合征的不同理解之间的一致性。
