04.19.08
Elderly patients and problems after surgery
The study found that elderly patients who developed these postoperative cognitive problems were more likely to die in the first year after surgery. Patients over the age of 60 who have elective surgeries such as joint replacements, hysterectomies and other non-emergency, inpatient procedures, are at an increased risk for long-term cognitive problems, according to a new study led by Duke University Medical Center researchers.
The researchers measured memory and the ability to process information in more than 1000 adult patients of different ages. Patients were tested preoperatively, at the time of hospital discharge, and three months after surgery. More than 200 control subjects took the same tests at the same frequency, but did not undergo surgery or anesthesia. The researchers published their findings in the January 1, 2008 issue of the journal Anesthesiology and the results were published early online on December 27, 2007 on the journal’s Web site. The article is accompanied by a supportive editorial and a companion article detailing the types of cognitive dysfunction that developed and the effects on patients’ daily lives. The study was funded by the National Institute on Aging, the Anesthesia Patient Safety Foundation and the I. Heerman Foundation.
The study found that many of the young, middle-aged and elderly patients experienced postoperative cognitive dysfunction (POCD) at the time they left the hospital. But three months later, those aged 60 and older were more than twice as likely to exhibit POCD. Those with POCD at both the time of hospital discharge and three months after surgery also were more likely to die within the first year after surgery.
Studies on normal aging have shown a link between abrupt cognitive decline and early death, so we speculated that surgery-related cognitive dysfunction might have the same effect.
Why some patients suffer POCD is not known, but one hypothesis is that surgery and the accompanying anesthesia might cause inflammation in the brain that can affect the patient’s ability to learn, retain or remember information. Now that the implications of long-term POCD are better understood, doctors must devise strategies to prevent or mitigate the detrimental effects of surgery and anesthesia on the aging brain. The types of interventions and how to implement them will be the subject of further research.
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