Outcomes associated with postoperative cognitive dysfunction: a systematic review and meta-analysis
Issued Date
2024-07-01
Resource Type
ISSN
00020729
eISSN
14682834
Scopus ID
2-s2.0-85199759852
Pubmed ID
39058915
Journal Title
Age and Ageing
Volume
53
Issue
7
Rights Holder(s)
SCOPUS
Bibliographic Citation
Age and Ageing Vol.53 No.7 (2024)
Suggested Citation
Suraarunsumrit P., Srinonprasert V., Kongmalai T., Suratewat S., Chaikledkaew U., Rattanasiri S., McKay G., Attia J., Thakkinstian A. Outcomes associated with postoperative cognitive dysfunction: a systematic review and meta-analysis. Age and Ageing Vol.53 No.7 (2024). doi:10.1093/ageing/afae160 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/100208
Title
Outcomes associated with postoperative cognitive dysfunction: a systematic review and meta-analysis
Corresponding Author(s)
Other Contributor(s)
Abstract
Background: Postoperative cognitive dysfunction (POCD) manifests as a subtle decline in cognition, potentially leading to unfavourable postoperative outcomes. We explored the impact of POCD on physical function, length of hospital stay (LOS), dementia and mortality outcomes. Methods: PubMed and Scopus were searched until May 2023. All studies of major surgical patients that assessed POCD and outcomes of interest were included. POCD effects were stratified by surgery type (cardiac and noncardiac) and time of POCD assessment (<30 and ≥30 days postsurgery). Results: Of 2316 studies, 20 met the inclusion criteria. POCD was not associated with functional decline postsurgery. Patients who experienced POCD postcardiac surgery had an increased relative risk (RR) of death of 2.04 [(95% CI: 1.18, 3.50); I2 = 0.00%]. Sensitivity analyses showed associations with intermediate-term mortality among noncardiac surgical patients, with an RR of 1.84 [(95% CI: 1.26, 2.71); I2 = 0.00%]. Patients who developed POCD <30 days postcardiac and noncardiac surgeries experienced longer LOS than those who did not [mean difference (MD) = 1.37 days (95% CI: 0.35, 2.39); I2 = 92.38% and MD = 1.94 days (95% CI: 0.48, 3.40); I2 = 83.29%, respectively]. Postoperative delirium (POD) may contribute to the heterogeneity observed, but limited data were reported within the studies included. Conclusions: Patients undergoing cardiac and noncardiac surgeries who developed POCD <30 days postsurgery had poorer outcomes and an increased risk of premature death. Early recognition of perioperative neurocognitive disorders in at-risk patients may enable early intervention. However, POD may confound our findings, with further studies necessary to disentangle the effects of POD from POCD on clinical outcomes.