Develop a Clinical Prediction Model for Postoperative Cognitive Dysfunction after Major Noncardiac Surgery in Elderly Patients: A Protocol for a Prospective Observational Study

Abstract

Perioperative neurocognitive disorders (PNDs) refer to cognitive decline identified in the preoperative or postoperative period. It has been reported that the incidence of postoperative neurocognitive impairment after noncardiac surgery in patients older than 65 at 1 week was 25.8∼41.4%, and at 3 months 9.9∼12.7%. PNDs will last months or even develop to permanent dementia, leading to prolonged hospital stays, reduced quality of life, and increased mortality within 1 year. Despite the high incidence and poor prognosis of PNDs in the aged population, no effective clinical prediction model has been established to predict postoperative cognitive decline preoperatively. To develop a clinical prediction model for postoperative neurocognitive dysfunction, a prospective observational study (Clinical trial registration number: ChiCTR2000036304) will be performed in the Shanghai General Hospital during January 2021 to October 2022. A sample size of 675 patients aged >65 years old, male or female, and scheduled for elective major noncardiac surgery will be recruited. A battery of neuropsychological tests will be used to test the cognitive function of patients at 1 week, 1 month, and 3 months postoperatively. We will evaluate the associations of PNDs with a bunch of candidate predictors including general characteristics of patients, blood biomarkers, indices associated with anesthesia and surgery, retinal nerve-fiber layer thickness, and frailty index to develop the clinical prediction model by using multiple logistic regression analysis and least absolute shrinkage and the selection operator (LASSO) method. The <i>k</i>-fold cross-validation method will be utilized to validate the clinical prediction model. In conclusion, this study was aimed to develop a clinical prediction model for postoperative cognitive dysfunction of old patients. It is anticipated that the knowledge gained from this study will facilitate clinical decision-making for anesthetists and surgeons managing the aged patients undergoing noncardiac surgery.

Which Predictor, SctO2 or SstO2, Is more Sensitive for Postoperative Cognitive Dysfunction in Spine Surgery: A Prospective Observational Study?

“…Finding sensitive and valid POCD predictors to accurately predict POCD risk remains a challenge. New rigorous research is also being explored 39,40 . Therefore, the current treatment strategies for these patients are multifaceted and this study may initially provide a valuable new approach to the prevention/early treatment of POCD from a new direction to facilitate early recovery.…”

Delirium after Cardiac Surgery—A Narrative Review

“…The incidence of postoperative cognitive dysfunction varies between studies, from as low as 11% at 3 months after cardiac surgery [27] to 41.4% at the time of discharge from the hospital [28]. Postoperative delirium can also be a contributing factor to postoperative cognitive dysfunction.…”

Incidence and Factors Related to Prolonged Postoperative Cognitive Decline (POCD) in Elderly Patients Following Surgery and Anaesthesia: A Systematic Review

“…14 Although POCD in some patients can stay for weeks to months, it can persist for longer periods (up to over a year), causing permanent dementia in some patients. [15][16][17][18] There is limited availability of data on the occurrence of POCD for prolonged periods and even persistent cognitive impairment. The purpose of this review is to explore if there is evidence showing prolonged POCD in elderly patients following anaesthesia and surgery, as these patients are potentially prone to developing permanent cognitive decline and dementia.…”