Abstract：
BACKGROUND: Peri-operative neurocognitive disorders are one of the most common complications affecting older adults after anaesthesia and surgery. It is not clear how exposure to surgery and anaesthesia contributes to the prevalence of long-term neurocognitive disorders. This study aimed to report the prevalence of neurocognitive disorders, and explore pre-operative factors associated with neurocognitive disorders 5 years after elective orthopaedic surgery.
METHODS: A prospective, 5-year longitudinal, cohort study was performed recruiting patients (aged ≥ 60 y) undergoing elective orthopaedic surgery and a contemporaneous non-surgical control group. Neurocognitive disorder was evaluated and classified at baseline and 5-year review incorporating: self- and informant-reported cognition; functional participation; and performance on neuropsychological tests.
RESULTS: Recruitment at 5-year follow-up included 195 patients and 21 control participants. In the patient cohort the prevalence of neurocognitive disorder was 38.1% (n = 75), with 61 (30.1%) meeting the criteria for mild neurocognitive disorder and 14 (7.1%) for major neurocognitive disorder. At 5-year follow-up, 121 (61.4%) patients were classified with a neurocognitive disorder, with 88 (44.7%) characterised with mild neurocognitive disorder and 33 (16.8%) with major neurocognitive disorder. Age (odds ratio (95%CI) 1.07 (1.02-1.13); p = 0.01) and baseline cognitive impairment (odds ratio (95%CI) 2.1 (1.06-4.15); p = 0.03) were significant predictors of neurocognitive disorder 5 years after surgery.
CONCLUSIONS: More than half of older adult patients had some form of neurocognitive disorder 5 years after elective orthopaedic surgery. Surgery and anaesthesia may be associated with the trajectory of cognitive decline in at-risk older adults, including those with pre-operative cognitive impairment. Cognitive screening should be factored into pre-operative assessments of older adults to inform subsequent care.
METHODS: A prospective, 5-year longitudinal, cohort study was performed recruiting patients (aged ≥ 60 y) undergoing elective orthopaedic surgery and a contemporaneous non-surgical control group. Neurocognitive disorder was evaluated and classified at baseline and 5-year review incorporating: self- and informant-reported cognition; functional participation; and performance on neuropsychological tests.
RESULTS: Recruitment at 5-year follow-up included 195 patients and 21 control participants. In the patient cohort the prevalence of neurocognitive disorder was 38.1% (n = 75), with 61 (30.1%) meeting the criteria for mild neurocognitive disorder and 14 (7.1%) for major neurocognitive disorder. At 5-year follow-up, 121 (61.4%) patients were classified with a neurocognitive disorder, with 88 (44.7%) characterised with mild neurocognitive disorder and 33 (16.8%) with major neurocognitive disorder. Age (odds ratio (95%CI) 1.07 (1.02-1.13); p = 0.01) and baseline cognitive impairment (odds ratio (95%CI) 2.1 (1.06-4.15); p = 0.03) were significant predictors of neurocognitive disorder 5 years after surgery.
CONCLUSIONS: More than half of older adult patients had some form of neurocognitive disorder 5 years after elective orthopaedic surgery. Surgery and anaesthesia may be associated with the trajectory of cognitive decline in at-risk older adults, including those with pre-operative cognitive impairment. Cognitive screening should be factored into pre-operative assessments of older adults to inform subsequent care.
摘要：
背景：围手术期神经认知障碍是影响老年人麻醉和手术后最常见的并发症之一。目前尚不清楚暴露于手术和麻醉如何导致长期神经认知障碍的流行。本研究旨在报道神经认知障碍的患病率,并探讨择期骨科手术后5年与神经认知障碍相关的术前因素。
方法：前瞻性，5年纵向，队列研究招募接受择期骨科手术的患者(年龄≥60岁)和同期非手术对照组.在基线和5年审查时对神经认知障碍进行了评估和分类，包括：自我和信息报告的认知；功能参与；以及神经心理学测试的表现。
结果：在5年随访时招募了195名患者和21名对照参与者。在患者队列中，神经认知障碍的患病率为38.1％（n=75），61（30.1％）符合轻度神经认知障碍的标准，14（7.1％）符合主要神经认知障碍的标准。在5年的随访中，121例（61.4%）患者被归类为神经认知障碍，其中88例(44.7%)患有轻度神经认知障碍，33例(16.8%)患有重度神经认知障碍。年龄(比值比(95CI)1.07(1.02-1.13);p=0.01)和基线认知障碍(比值比(95CI)2.1(1.06-4.15);p=0.03)是术后5年神经认知障碍的显著预测因子。
结论：超过一半的老年患者在择期骨科手术5年后出现某种形式的神经认知障碍。手术和麻醉可能与高危老年人认知功能下降的轨迹有关。包括术前认知障碍患者.认知筛查应纳入老年人的术前评估，以告知后续护理。
方法：前瞻性，5年纵向，队列研究招募接受择期骨科手术的患者(年龄≥60岁)和同期非手术对照组.在基线和5年审查时对神经认知障碍进行了评估和分类，包括：自我和信息报告的认知；功能参与；以及神经心理学测试的表现。
结果：在5年随访时招募了195名患者和21名对照参与者。在患者队列中，神经认知障碍的患病率为38.1％（n=75），61（30.1％）符合轻度神经认知障碍的标准，14（7.1％）符合主要神经认知障碍的标准。在5年的随访中，121例（61.4%）患者被归类为神经认知障碍，其中88例(44.7%)患有轻度神经认知障碍，33例(16.8%)患有重度神经认知障碍。年龄(比值比(95CI)1.07(1.02-1.13);p=0.01)和基线认知障碍(比值比(95CI)2.1(1.06-4.15);p=0.03)是术后5年神经认知障碍的显著预测因子。
结论：超过一半的老年患者在择期骨科手术5年后出现某种形式的神经认知障碍。手术和麻醉可能与高危老年人认知功能下降的轨迹有关。包括术前认知障碍患者.认知筛查应纳入老年人的术前评估，以告知后续护理。
