Cognitive Changes after Surgery in the Elderly: Does Minimally Invasive Surgery Influence the Incidence of Postoperative Cognitive Changes Compared to Open Colon Surgery?

Abstract

Background: Postoperative delirium in the elderly is a growing concern. Data regarding significant differences in postoperative cognitive dysfunction (POCD) in elderly persons undergoing laparoscopic versus open colon resection are not well established. Objectives: The goal of this study was to compare the incidence of POCD in laparoscopic versus open colon surgery in an elderly population. Design and Setting: A prospective nonrandomized pilot study was conducted at an urban tertiary care hospital. Participants: The study included patients aged 65 years and above, without documented dementia who underwent elective colon surgery. Measurements: We collected demographic and clinical data, including age, sex, polypharmacy, and comorbidities. The subjects underwent pre- and postoperative Cambridge Neuropsychological Test Automated Battery (CANTAB) testing. Worsening individual scores from the Paired Associated Learning (PAL) and Spatial Working Memory (SWM) portions of CANTAB determined the presence of POCD. Inflammatory cytokine (i.e., IL-6) levels were measured pre- and postoperatively. Results: We enrolled 44 subjects (26 laparoscopic and 18 open surgery). The two groups did not differ significantly in age, sex, polypharmacy, and comorbidities. The average incidence of POCD was 47%. PAL scores worsened in 12/23 (52%) in the laparoscopic group and in 7/15 (47%) in the open group. These group differences lacked statistical significance (p = 0.75). SWM scores worsened in 14/25 (56%) in the laparoscopic group and in 6/18 (33%) in the open group, which was also not statistically significant (p = 0.12). No age difference occurred between the ‘worsened scores' group and ‘stable scores' group, and older age was not associated with POCD. IL-6 levels were higher in the open versus the laparoscopic group (p < 0.0001). Conclusion: In this pilot study, the average incidence of POCD was not statistically different between elderly subjects undergoing open versus laparoscopic surgery. Age did not influence the occurrence of POCD. Although inflammatory markers were significantly higher in the open group, consistent with a higher degree of stress response, this group did not have higher rates of delirium. This association is worth to be investigated in a larger sample. © 2014 S. Karger AG, Basel

Impact of surgical approach on postoperative delirium in elderly patients undergoing gastrectomy: laparoscopic versus open approaches

“…Thus, a reasonable explanation for our result is that the difference in the degree of surgical trauma and subsequent inflammation was not large enough to see a difference in the development of delirium between the groups. This assumption is supported by a recent prospective study [ 15 ], in which the incidence of postoperative delirium was similar between elderly patients undergoing open versus laparoscopic colectomy. Unlike our study, that study evaluated serum levels of inflammatory markers, and found that the interleukine-6 levels were higher in the open group than in the laparoscopic group.…”

Effect of flurbiprofen axetil on postoperative delirium for elderly patients

“…In this study, there was a higher number of POD (25.9% vs. 14%) cases in patients undergoing minimally invasive surgery (MIS) than in patients undergoing open surgery, respectively, but this difference did not reach statistical significance. It was indicated that patients undergoing MIS suffered a less incidence of POD and lower inflammatory markers compared with those with open surgeries, consistent with a lower degree of stress response (Tan et al, ). However, recent work suggested that intraoperative CO 2 control may be an independent marker of POD risk (El‐Gabalawy et al, ; Mutch & El‐Gabalawy, ).…”

“…The aging brain exhibits increased vulnerability due to reduced cholinergic reserves and a high prevalence of cognitive impairment (Ljubisavljevic & Kelly, 2003). with those with open surgeries, consistent with a lower degree of stress response (Tan et al, 2015). However, recent work suggested that intraoperative CO 2 control may be an independent marker of POD risk .…”

Diabetes, but Not Hypertension and Obesity, Is Associated with Postoperative Cognitive Dysfunction

“…Large individual differences in POCD spanning cognitive recovery during the first few months to persistent cognitive impairment have been reported [1-5]. Although it has been the subject of extensive research during the past two decades, many questions remain unanswered, and a lack of uniform diagnostic criteria [6] and differences in length of follow-up period hamper comparability between studies.…”