老年患者全身麻醉下的术前认知功能与手术结局

Preoperative cognitive function and surgical outcomes under general anesthesia among older patients.

作者信息

Oh Tak Kyu, Song In-Ae

机构信息

Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea; Department of Anesthesiology and Pain Medicine, College of Medicine, Seoul National University, Seoul, South Korea.

出版信息

J Clin Anesth. 2025 Jun;104:111852. doi: 10.1016/j.jclinane.2025.111852. Epub 2025 May 7.

DOI:10.1016/j.jclinane.2025.111852

PMID:40339183

Abstract

PURPOSE

To investigate whether preoperative cognitive impairment is associated with postoperative outcomes under general anesthesia.

METHODS

This population-based cohort study utilized a nationwide database in South Korea. We included patients who underwent surgery under general anesthesia at the hospital between January 1, 2021, and December 31, 2021. The Korean Dementia Screening Questionnaire-Cognition (KDSQ-C), a tool designed for efficient dementia screening, was used to evaluate preoperative cognitive impairment. The KDSQ-C is administered during biennial National Health Insurance Service medical evaluations beginning at age 66 years.

RESULTS

This study included 108,158 older patients who underwent surgery under general anesthesia. In a multivariable Cox regression model, patients with KDSQ-C ≥ 6 had a 35 % higher risk of 90-day mortality than those with KDSQ-C of 0-5 (hazard ratio [HR]: 1.35, 95 % confidence interval [CI]: 1.15, 1.57; P < 0.001). Increased 90-day mortality was observed in the following KDSQ-C groups compared to those with a score of 0-5: KDSQ-C 11-15 (HR: 1.54, 95 % CI: 1.13, 2.11; P = 0.007), KDSQ-C 16-20 (HR: 1.98, 95 % CI: 1.31, 2.99; P = 0.001), KDSQ-C 21-25 (HR: 1.99, 95 % CI: 1.29, 2.57; P = 0.004), and KDSQ-C 26-30 (HR: 2.03, 95 % CI: 1.26, 3.28; P = 0.004). Similar results were found in the analyses of one-year all-cause mortality and postoperative complications.

CONCLUSIONS

Older patients with preoperative cognitive impairment undergoing general anesthesia have higher mortality and morbidity rates, particularly in patients with KDSQ-C scores ≥11.

摘要

目的

探讨术前认知障碍与全身麻醉下术后结局是否相关。

方法

这项基于人群的队列研究使用了韩国的一个全国性数据库。我们纳入了2021年1月1日至2021年12月31日期间在该医院接受全身麻醉手术的患者。韩国痴呆筛查问卷-认知版（KDSQ-C），一种专为高效痴呆筛查设计的工具，用于评估术前认知障碍。KDSQ-C在66岁开始的两年一次的国民健康保险服务医疗评估期间进行发放。

结果

本研究纳入了108158例接受全身麻醉手术的老年患者。在多变量Cox回归模型中，KDSQ-C≥6的患者90天死亡率比KDSQ-C为0-5的患者高35%（风险比[HR]：1.35，95%置信区间[CI]：1.15，1.57；P<0.001）。与得分0-5的患者相比，在以下KDSQ-C组中观察到90天死亡率增加：KDSQ-C 11-15（HR：1.54，95%CI：1.13，2.11；P=0.007），KDSQ-C 16-20（HR：1.98，95%CI：1.31，2.99；P=0.001），KDSQ-C 21-25（HR：1.99，95%CI：1.29，2.57；P=0.004），以及KDSQ-C 26-30（HR：2.03，95%CI：1.26，3.28；P=0.004）。在一年全因死亡率和术后并发症分析中发现了类似结果。