4.6 Article

Cognitive Functioning after Surgery in Middle-aged and Elderly Danish Twins

Journal

ANESTHESIOLOGY
Volume 124, Issue 2, Pages 312-321

Publisher

LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/ALN.0000000000000957

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Funding

  1. National Program for Research Infrastructure, the Danish Agency for Science Technology and Innovation, Copenhagen, Denmark [09-063256]
  2. VELUX Foundation, Copenhagen, Denmark
  3. U.S. National Institutes of Health, Bethesda, Maryland [P01 AG08761]
  4. Tryg Foundation, Virum, Denmark

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Background: Postoperative cognitive dysfunction is common, but it remains unclear whether there are long-term adverse cognitive effects of surgery combined with anesthesia. The authors examined the association between exposure to surgery and level of cognitive functioning in a sample of 8,503 middle-aged and elderly twins. Methods: Results from five cognitive tests were compared in twins exposed to surgery, classified as major, minor, hip and knee replacement, or other, with those of a reference group without surgery using linear regression adjusted for sex and age. Genetic and shared environmental confounding was addressed in intrapair analyses of 87 monozygotic and 124 dizygotic same-sexed twin pairs in whom one had a history of major surgery and the other did not. Results: Statistically significantly lower composite cognitive score was found in twins with at least one major surgery compared with the reference group (mean difference, -0.27; 95% CI, -0.48 to -0.06), corresponding to one tenth of an SD, that is, a negligible effect size. In the intrapair analysis, the surgery-exposed co-twin had the lower cognitive score in 49% (95% CI, 42 to 56%) of the pairs. None of the other groups differed from the reference group except the knee and hip replacement group that tended to have higher cognitive scores (mean difference, 0.35; 95% CI, -0.18 to 0.87). Conclusions: A history of major surgery was associated with a negligibly lower level of cognitive functioning. The supplementary analyses suggest that preoperative cognitive functioning and underlying diseases were more important for cognitive functioning in mid- and late life than surgery and anesthesia.

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