择期骨科手术后 5 年内神经认知障碍的患病率。

Prevalence of neurocognitive disorders 5 years after elective orthopaedic surgery.

机构信息

Department of Anesthesiology, Weill Cornell Medicine, New York, NY, USA.

Department of Critical Care, Melbourne Medical School, University of Melbourne, Melbourne, VIC, Australia.

出版信息

Anaesthesia. 2024 Oct;79(10):1053-1061. doi: 10.1111/anae.16365. Epub 2024 Jul 10.

DOI:10.1111/anae.16365

PMID:38985478

Abstract

BACKGROUND

Peri-operative neurocognitive disorders are one of the most common complications affecting older adults after anaesthesia and surgery. It is not clear how exposure to surgery and anaesthesia contributes to the prevalence of long-term neurocognitive disorders. This study aimed to report the prevalence of neurocognitive disorders, and explore pre-operative factors associated with neurocognitive disorders 5 years after elective orthopaedic surgery.

METHODS

A prospective, 5-year longitudinal, cohort study was performed recruiting patients (aged ≥ 60 y) undergoing elective orthopaedic surgery and a contemporaneous non-surgical control group. Neurocognitive disorder was evaluated and classified at baseline and 5-year review incorporating: self- and informant-reported cognition; functional participation; and performance on neuropsychological tests.

RESULTS

Recruitment at 5-year follow-up included 195 patients and 21 control participants. In the patient cohort the prevalence of neurocognitive disorder was 38.1% (n = 75), with 61 (30.1%) meeting the criteria for mild neurocognitive disorder and 14 (7.1%) for major neurocognitive disorder. At 5-year follow-up, 121 (61.4%) patients were classified with a neurocognitive disorder, with 88 (44.7%) characterised with mild neurocognitive disorder and 33 (16.8%) with major neurocognitive disorder. Age (odds ratio (95%CI) 1.07 (1.02-1.13); p = 0.01) and baseline cognitive impairment (odds ratio (95%CI) 2.1 (1.06-4.15); p = 0.03) were significant predictors of neurocognitive disorder 5 years after surgery.

CONCLUSION

More than half of older adult patients had some form of neurocognitive disorder 5 years after elective orthopaedic surgery. Surgery and anaesthesia may be associated with the trajectory of cognitive decline in at-risk older adults, including those with pre-operative cognitive impairment. Cognitive screening should be factored into pre-operative assessments of older adults to inform subsequent care.

摘要

背景

围手术期神经认知障碍是影响麻醉和手术后老年人的最常见并发症之一。目前尚不清楚手术和麻醉的暴露如何导致长期神经认知障碍的流行。本研究旨在报告神经认知障碍的流行情况，并探讨择期骨科手术后 5 年内与神经认知障碍相关的术前因素。

方法

进行了一项前瞻性、5 年纵向队列研究，招募了接受择期骨科手术的患者（年龄≥60 岁）和同期非手术对照组。在基线和 5 年回顾时评估和分类神经认知障碍，包括：自我和知情人报告的认知；功能参与；以及神经心理学测试的表现。

结果

在 5 年随访时，共纳入 195 名患者和 21 名对照参与者。在患者队列中，神经认知障碍的患病率为 38.1%（n=75），其中 61 例（30.1%）符合轻度神经认知障碍标准，14 例（7.1%）符合重度神经认知障碍标准。在 5 年随访时，121 例（61.4%）患者被归类为神经认知障碍，其中 88 例（44.7%）为轻度神经认知障碍，33 例（16.8%）为重度神经认知障碍。年龄（优势比（95%CI）1.07（1.02-1.13）；p=0.01）和基线认知障碍（优势比（95%CI）2.1（1.06-4.15）；p=0.03）是术后 5 年神经认知障碍的显著预测因素。