Department of Anaesthetics, Royal Prince Alfred Hospital, Sydney Local Health District, Sydney, NSW, Australia; NHMRC Clinical Trials Centre, The University of Sydney, Sydney, NSW, Australia; Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
NHMRC Clinical Trials Centre, The University of Sydney, Sydney, NSW, Australia.
Lancet Healthy Longev. 2024 Sep;5(9):100623. doi: 10.1016/j.lanhl.2024.07.006. Epub 2024 Sep 5.
Previous studies have shown that major surgical and medical hospital admissions are associated with cognitive decline in older people (aged 40-69 years at recruitment), which is concerning for patients and caregivers. We aimed to validate these findings in a large cohort and investigate associations with neurodegeneration using MRI.
For this population-based study, we analysed data from the UK Biobank collected from March 13, 2006, to July 16, 2023, linked to the National Health Service Hospital Episode Statistics database, excluding participants with dementia diagnoses. We constructed fully adjusted models that included age, time, sex, Lancet Commission dementia risk factors, stroke, and hospital admissions with a participant random effect. Primary outcomes were hippocampal volume and white matter hyperintensities, both of which are established markers of neurodegeneration, and exploratory analyses investigated the cortical thickness of Desikan-Killiany-Tourville atlas regions. The main cognitive outcomes were reaction time, fluid intelligence, and prospective and numeric memory. Surgeries were calculated cumulatively starting from 8 years before the baseline evaluation.
Of 502 412 participants in the UK Biobank study, 492 802 participants were eligible for inclusion in this study, of whom 46 706 underwent MRI. Small adverse associations with cognition were found per surgery: reaction time increased by 0·273 ms, fluid intelligence score decreased by 0·057 correct responses, prospective memory (scored as correct at first attempt) decreased (odds ratio 0·96 [95% CI 0·95 to 0·97]), and numeric memory maximum correct matches decreased by 0·025 in fully adjusted models. Surgeries were associated with smaller hippocampal volume (β=-5·76 mm³ [-7·89 to -3·64]) and greater white matter hyperintensities volume (β=100·02 mm³ [66·17 to 133·87]) in fully adjusted models. Surgeries were also associated with neurodegeneration of the insula and superior temporal cortex.
This population-based study corroborates that surgeries are generally safe but cumulatively are associated with cognitive decline and neurodegeneration. Perioperative brain health should be prioritised for older and vulnerable patients, particularly those who have multiple surgical procedures.
The Australian and New Zealand College of Anaesthetists (ANZCA) Foundation and the University of Sydney.
先前的研究表明，重大手术和内科住院与老年人（招募时年龄为 40-69 岁）的认知能力下降有关，这让患者和护理人员感到担忧。我们旨在通过 MRI 对大型队列进行验证，并研究其与神经退行性变的关联。
在这项基于人群的研究中，我们分析了 2006 年 3 月 13 日至 2023 年 7 月 16 日期间从英国生物库收集的数据，这些数据与国民保健系统医院发病统计数据库相关联，但排除了有痴呆症诊断的参与者。我们构建了完全调整的模型，包括年龄、时间、性别、柳叶刀委员会痴呆风险因素、中风和有参与者随机效应的住院治疗。主要结局是海马体体积和脑白质高信号，这两者都是神经退行性变的既定标志物，探索性分析调查了 Desikan-Killiany-Tourville 图谱区域的皮质厚度。主要认知结局是反应时间、流体智力以及前瞻性和数字记忆。手术是从基线评估前 8 年开始累积计算的。
在英国生物库研究中，共有 502412 名参与者，其中 492802 名参与者符合纳入本研究的条件，其中 46706 名参与者接受了 MRI。每进行一次手术，认知能力就会出现轻微的负面关联：反应时间增加 0.273 毫秒，流体智力评分下降 0.057 个正确答案，前瞻性记忆（首次尝试正确）下降（比值比 0.96[95%CI 0.95 至 0.97]），数字记忆最大正确匹配减少 0.025 在完全调整的模型中。手术与海马体体积较小（β=-5.76mm³[-7.89 至-3.64]）和脑白质高信号体积较大（β=100.02mm³[66.17 至 133.87]）有关，这是在完全调整的模型中发现的。手术还与脑岛和上颞叶皮质的神经退行性变有关。
这项基于人群的研究证实，手术通常是安全的，但会累积导致认知能力下降和神经退行性变。应优先关注老年和脆弱患者的围手术期大脑健康，特别是那些接受多次手术的患者。
澳大利亚和新西兰麻醉师学院（ANZCA）基金会和悉尼大学。
