The Influencing Factors of Early Postoperative Cognitive Dysfunction after General Anesthesia in Elderly Patients

Abstract

Objective To investigate the influencing factors of early postoperative cognitive dysfunction (POCD) in elderly patients undergoing general anesthesia. Methods A total of 129 elderly patients hospitalized under general anesthesia who underwent elective surgery in Xi’an Fifth Hospital from October 2021 to October 2023 were selected as the study subjects. The preoperative general conditions, underlying disease history and hemoglobin content were recorded. The preoperative mean blood flow velocity of bilateral middle cerebral arteries and breath holding index (BHI) were assessed by transcranial doppler. The intraoperative anesthesia time, blood loss, hypothermia and hypotension were recorded. Cognitive function was assessed by the Mini-Mental State Examination (MMSE) 1 day before surgery and 1 week after surgery in elderly patients, and POCD was considered to be present if the postoperative MMSE score was lower than ≥2 points before surgery. Results A total of 36 patients who developed POCD after surgery were in the POCD group, and the remaining 93 patients who did not develop POCD were in the non-POCD group. POCD group education level was lower than non-POCD group (P<0.05), hypertension, coronary heart disease, hyperlipidemia, intraoperative hypothermia, intraoperative hypotension ratio were higher than non-POCD group (P<0.05), anesthesia duration was given in non-POCD group (P<0.05), intraoperative blood loss was more than non-POCD group (P<0.05). 1 day before surgery, POCD group MMSE score was lower than non-POCD group (P<0.05). 1 week after surgery, POCD group MMSE score was lower than 1 day before surgery and also lower than non-POCD group (P<0.05). The hemoglobin and BHI of the POCD group were all lower thah those in the non-POCD group（P<0.05）.Multivariate logistic regression results suggested that: combined hypertension, intraoperative blood loss were independent influencing factors for the occurrence of POCD (P<0.05), while preoperative hemoglobin and BHI were protective factors for the occurrence of POCD (P<0.05). Conclusion Hypertension, hemoglobin, BHI, and intraoperative bleeding are influencing factors for POCD and have good predictive value for short-term POCD occurrence, which can be used to evaluate cognitive function decline after general anesthesia.

Keywords

• postoperative cognitive dysfunction
• risk factors
• hemoglobin
• hemodynamics