Journal
JOURNAL OF INTERNATIONAL MEDICAL RESEARCH
Volume 40, Issue 2, Pages 612-620Publisher
FIELD HOUSE PUBLISHING LLP
DOI: 10.1177/147323001204000223
Keywords
SEVERE SYSTEMIC DISEASE; COGNITIVE DYSFUNCTION; POSTOPERATIVE; RISK FACTORS; AMERICAN SOCIETY OF ANESTHESIOLOGISTS (ASA); PHYSICAL STATUS
Funding
- Charite - University of Medicine Berlin, Berlin, Germany
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OBJECTIVE: To determine the relevance of surgery and other causative factors to the incidence of postoperative cognitive dysfunction (POCD) in patients with severe systemic disease. METHODS: This observational study included 107 noncardiac surgical patients and 26 nonsurgical control subjects, all of whom had an American Society of Anesthesiologists physical classification status of 3. Cognitive assessment was performed preoperatively and 7 days postoperatively, or with a 7-day interval for the control group. POCD was calculated as a combined Z-score. Mini Mental State Examination (MMSE) was used to exclude patients with pre-existing cognitive deficit (MMSE score 23). Surgical and other factors including duration of surgery/anaesthesia and length of stay in the intensive care unit (ICU) were recorded. RESULTS: After 7 days, POCD was found in 40/107 (37.4%) surgical patients compared with 4/26 (15.4%) nonsurgical controls. Preoperative MMSE score, duration of surgery/anaesthesia, and length of stay in the ICU and hospital were associated with POCD. Logistic regression analysis revealed that preoperative MMSE score was an independent predictor of POCD. CONCLUSION: Lower baseline MMSE score was the only independent predictor for POCD in patients with severe systemic disease.
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