Abstract：
OBJECTIVE: Postoperative cognitive decline (POCD) is characterised by deficits in attention, memory, executive function, and information processing that persist beyond the early postoperative period. Its incidence ranges from 10%-25% after noncardiac surgery. Limited literature exists on POCD after gynecologic oncology surgery. Our primary objective was to identify the incidence of POCD among patients 55 years or older undergoing major gynecologic oncology surgery.
METHODS: This mixed-methods, prospective, observational cohort study followed patients 55 years or older who underwent surgery for gynecologic malignancies between February and July 2022. Semi-structured interviews and the Mini-Mental State Exam (MMSE) were administered before surgery as well as 1 and 3 months after. Assessments were delivered virtually and in-person in the context of the COVID-19 pandemic. POCD was defined as ≥2-point decline from baseline MMSE score.
RESULTS: Twenty-four patients participated; 19 completed the 1-month follow-up, and 15 completed the 3-month follow-up. The average age was 64 (range: 56-90). The mean preoperative MMSE score was 16.6 out of 17 (virtual) and 12.9 out of 13 (in-person). Two patients had a 1-point decline in their 1-month MMSE score; both recovered by 3 months. One patient had a 1-point decline in their 3-month MMSE score. Semi-structured interviews revealed common themes of \"brain fog\" at the 1-month follow-up and mild, persistent attention and word-finding deficits at 3 months postoperatively.
CONCLUSIONS: This study\'s qualitative component captured subtle subjective findings suggestive of potential POCD. Larger studies are required, and a more extensive neuropsychological test battery may be required to elicit subtle findings not clearly reflected by MMSE scores.
METHODS: This mixed-methods, prospective, observational cohort study followed patients 55 years or older who underwent surgery for gynecologic malignancies between February and July 2022. Semi-structured interviews and the Mini-Mental State Exam (MMSE) were administered before surgery as well as 1 and 3 months after. Assessments were delivered virtually and in-person in the context of the COVID-19 pandemic. POCD was defined as ≥2-point decline from baseline MMSE score.
RESULTS: Twenty-four patients participated; 19 completed the 1-month follow-up, and 15 completed the 3-month follow-up. The average age was 64 (range: 56-90). The mean preoperative MMSE score was 16.6 out of 17 (virtual) and 12.9 out of 13 (in-person). Two patients had a 1-point decline in their 1-month MMSE score; both recovered by 3 months. One patient had a 1-point decline in their 3-month MMSE score. Semi-structured interviews revealed common themes of \"brain fog\" at the 1-month follow-up and mild, persistent attention and word-finding deficits at 3 months postoperatively.
CONCLUSIONS: This study\'s qualitative component captured subtle subjective findings suggestive of potential POCD. Larger studies are required, and a more extensive neuropsychological test battery may be required to elicit subtle findings not clearly reflected by MMSE scores.
摘要：
背景：术后认知功能下降（POCD）的特征是注意力不足，记忆,执行功能，和信息处理持续到术后早期。非心脏手术后其发病率为10％-25％。关于妇科肿瘤外科手术后POCD的文献有限。
目的：我们的主要目的是确定55岁以上接受妇科肿瘤大手术患者POCD的发生率。
方法：这种混合方法，prospective,观察性队列研究对2022年2月至7月间接受妇科恶性肿瘤手术的55岁或以上患者进行了随访.在手术前以及手术后1个月和3个月进行半结构化访谈和迷你精神状态检查（MMSE）。在COVID-19大流行的背景下，评估是虚拟和亲自进行的。POCD定义为从基线MMSE评分下降≥两点。
结果：24名患者参加；19名患者完成了1个月的随访，15人完成了3个月的随访。平均年龄为64岁（范围：56-90岁）。术前平均MMSE评分为17分的16.6分（虚拟）和13分的12.9分（当面）。两名患者的1个月MMSE评分下降了1分；两者都恢复了3个月。一名患者的3个月MMSE评分下降1分。半结构化访谈在1个月的随访中揭示了“脑雾”和轻度的共同主题，术后3个月的持续注意力和单词发现缺陷。
结论：本研究的定性成分捕获了暗示潜在POCD的微妙主观发现。需要更大的研究，并且可能需要进行更广泛的神经心理学测试才能得出MMSE评分未明确反映的微妙发现。
目的：我们的主要目的是确定55岁以上接受妇科肿瘤大手术患者POCD的发生率。
方法：这种混合方法，prospective,观察性队列研究对2022年2月至7月间接受妇科恶性肿瘤手术的55岁或以上患者进行了随访.在手术前以及手术后1个月和3个月进行半结构化访谈和迷你精神状态检查（MMSE）。在COVID-19大流行的背景下，评估是虚拟和亲自进行的。POCD定义为从基线MMSE评分下降≥两点。
结果：24名患者参加；19名患者完成了1个月的随访，15人完成了3个月的随访。平均年龄为64岁（范围：56-90岁）。术前平均MMSE评分为17分的16.6分（虚拟）和13分的12.9分（当面）。两名患者的1个月MMSE评分下降了1分；两者都恢复了3个月。一名患者的3个月MMSE评分下降1分。半结构化访谈在1个月的随访中揭示了“脑雾”和轻度的共同主题，术后3个月的持续注意力和单词发现缺陷。
结论：本研究的定性成分捕获了暗示潜在POCD的微妙主观发现。需要更大的研究，并且可能需要进行更广泛的神经心理学测试才能得出MMSE评分未明确反映的微妙发现。
