Khan Zeeshan A, Duran Tahiris A, Sumsuzzman Dewan Md, Ju Ling-Sha, Seubert Christoph N, Martynyuk Anatoly E
Department of Anesthesiology, College of Medicine, University of Florida, JHMHC, 1600 SW Archer Road, P.O. Box 100254, Gainesville, FL 32610-0254, USA.
Agent-Based Modelling Laboratory, York University, Toronto, ON M3J 1P3, Canada.
Biology (Basel). 2025 May 31;14(6):640. doi: 10.3390/biology14060640.
Accelerated neurocognitive decline associated with surgeries under general anesthesia (GA), a phenomenon referred to as postoperative neurocognitive disorder (PND), is a significant public health concern. It not only poses inherent risks but may also contribute to the development of other neurodegenerative disorders. We systematically searched five databases for studies examining cognitive function in patients with mild-to-moderate TBI with (participant) or without (control) subsequent extracranial surgeries/GA. A random effects model was applied to calculate mean differences (MDs) and 95% confidence intervals (CIs). Five outcomes were analyzed post hoc: trail-making tests A and B (TMT-A/B), Glasgow Outcome Scale-Extended (GOSE), and length of stay (LOS) in intensive care units (ICUs) and hospitals. Five studies met the criteria for our meta-analysis. Patients with a history of mild-to-moderate TBI who underwent extracranial surgeries/GA exhibited worse outcomes in TMT-A [MD = 2.04; CI 0.38-3.70; = 0.016] and TMT-B [MD = 16.59; CI 9.58-23.60; < 0.001]. Differences in the ICU and hospital LOS and GOSE between the study groups were insignificant. Our results suggest that extracranial surgeries/GA may worsen neurocognitive outcomes without affecting functional recovery in mild-to-moderate TBI patients. Given the limited number of studies identified and the high incidence of TBI, more research on PND in TBI patients is warranted.
与全身麻醉（GA）下手术相关的神经认知功能加速衰退，即所谓的术后神经认知障碍（PND），是一个重大的公共卫生问题。它不仅带来内在风险，还可能促使其他神经退行性疾病的发展。我们系统检索了五个数据库，以查找有关轻度至中度创伤性脑损伤（TBI）患者在接受（参与者）或未接受（对照组）后续颅外手术/GA后认知功能的研究。应用随机效应模型计算平均差异（MDs）和95%置信区间（CIs）。事后分析了五个结果：连线测验A和B（TMT-A/B）、格拉斯哥扩展预后量表（GOSE）以及重症监护病房（ICU）和医院的住院时间（LOS）。五项研究符合我们的荟萃分析标准。有轻度至中度TBI病史且接受颅外手术/GA的患者在TMT-A [MD = 2.04；CI 0.38 - 3.70； = 0.016]和TMT-B [MD = 16.59；CI 9.58 - 23.60； < 0.001]方面表现出更差的结果。研究组之间在ICU和医院住院时间以及GOSE方面的差异不显著。我们的结果表明，颅外手术/GA可能会使轻度至中度TBI患者的神经认知结果恶化，但不影响功能恢复。鉴于已确定的研究数量有限以及TBI的高发病率，有必要对TBI患者的PND进行更多研究。
