ORIGINAL ARTICLE   

Minerva Anestesiologica 2024 March;90(3):135-43

DOI: 10.23736/S0375-9393.23.17572-9

Copyright © 2023 EDIZIONI MINERVA MEDICA

language: English

Postoperative cognitive worsening in seniors with an age above life expectancy: a prospective longitudinal study

Gabriele MELEGARI ¹ ✉, Enrico GIULIANI ², Suela OSMENAJ ³, Silvio MALAGUTI ³, Michele ZOLI ⁴, Stefano MELETTI ⁵, Elisabetta BERTELLINI ¹, Luciana MASCIA ⁶, Alberto BARBIERI ³

¹ Department of Anesthesia and Intensive Care, Modena University Hospital, Modena, Italy; ² Neuron Guard, Ltd., Cambridge, UK; ³ School of Anesthesia and Intensive Care, University of Modena and Reggio Emilia, Modena, Italy; ⁴ Postgraduate Program in Neurosciences, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy; ⁵ Department of Neurology, Modena University Hospital, Modena, Italy; ⁶ Department of Anesthesia and Intensive Care, Alma Mater Studiorum University of Bologna, Bologna, Italy

BACKGROUND: The growing number of elderly patients in hospitals is a challenge for healthcare systems. The main objective is to measure the postoperative change in the cognitive status at hospital discharge and one year after discharge in elderly patients undergoing planned or deferrable surgery.
METHODS: We planned a prospective longitudinal study, single-center study: secondary care level hospital, enrolment from September 2018 to May 2019. We enroll elderly patients, aged above life expectancy in Italy, who underwent planned or deferrable surgery (men over 80.5 years old, women over 85.0 years old). In six months, we enrolled 76 eligible patients. We collected the scores of the clinical impairment scales Charlson Index, Barthel Index, and Six-Item Cognitive Impairment Test (6CIT). The primary endpoint was the postoperative worsening of the cognitive status at one-year follow-up. Secondary endpoints aimed to describe postoperative disabilities and complications, to investigate possible risk factors for cognitive worsening, and to measure the role of anesthesia in cognitive changes.
RESULTS: We recorded an increased rate of pathological 6CIT values during the hospitalization period, rising from 39.47% to 55.26% (McNemar test, P=0.007), and this rate was still increased at 55.56% (P=0.021) one year after discharge. Anesthesia did not show any significant harmful effect on cognitive status. The preoperative hemoglobin value seems to be a risk factor for cognitive status and one-year mortality.
CONCLUSIONS: Elderly patients had a significantly worse 6CIT value after planned surgery, which may derive in part from age and in part from hospitalization. It is difficult to determine if general anesthesia alone has no harmful effects on cognitive performance in patients at discharge and one year later. Further data are necessary.

KEY WORDS: Postoperative complications; Cognitive dysfunction; Aged; Life expectancy