Long-term consequences of postoperative cognitive dysfunction

Jacob Steinmetz; Karl Bang Christensen; Thomas Lund; Nicolai Lohse; Lars S Rasmussen; ISPOCD Group

doi:10.1097/ALN.0b013e318195b569

Long-term consequences of postoperative cognitive dysfunction

Jacob Steinmetz, Karl Bang Christensen, Thomas Lund, Nicolai Lohse, Lars S Rasmussen, ISPOCD Group

577 Citations (Scopus)

Abstract

BACKGROUND: Postoperative cognitive dysfunction (POCD) is common in elderly patients after noncardiac surgery, but the consequences are unknown. The authors' aim was to determine the effects of POCD on long-term prognosis. METHODS: This was an observational study of Danish patients enrolled in two multicenter studies of POCD between November 1994 and October 2000. The cohort was followed up from the date of surgery until August 2007. Cognitive function was assessed by a neuropsychological test battery at three time points: before, at 1 week after, and at 3 months after noncardiac surgery. Data on survival, labor market attachment, and social transfer payments were obtained from administrative databases. The Cox proportional hazards regression model was used to compute relative risk estimates for mortality and disability, and the relative prevalence of time on social transfer payments was assessed by Poisson regression. RESULTS: A total of 701 patients were followed up for a median of 8.5 yr (interquartile range, 5.3-11.4 yr). POCD at 3 months, but not at 1 week, was associated with increased mortality (hazard ratio, 1.63 [95% confidence interval, 1.11-2.38]; P = 0.01, adjusted for sex, age, and cancer). The risk of leaving the labor market prematurely because of disability or voluntary early retirement was higher among patients with 1-week POCD (hazard ratio, 2.26 [1.24-4.12]; P = 0.01). Patients with POCD at 1 week received social transfer payments for a longer proportion of observation time (prevalence ratio, 1.45 [1.03-2.04]; P = 0.03). CONCLUSIONS: Cognitive dysfunction after noncardiac surgery was associated with increased mortality, risk of leaving the labor market prematurely, and dependency on social transfer payments.

Original language	English
Journal	Anesthesiology
Volume	110
Issue number	3
Pages (from-to)	548-55
Number of pages	7
ISSN	0003-3022
DOIs	https://doi.org/10.1097/ALN.0b013e318195b569
Publication status	Published - 2009

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10.1097/ALN.0b013e318195b569

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@article{a3f46eb060c611de8bc9000ea68e967b,

title = "Long-term consequences of postoperative cognitive dysfunction",

abstract = "BACKGROUND: Postoperative cognitive dysfunction (POCD) is common in elderly patients after noncardiac surgery, but the consequences are unknown. The authors' aim was to determine the effects of POCD on long-term prognosis. METHODS: This was an observational study of Danish patients enrolled in two multicenter studies of POCD between November 1994 and October 2000. The cohort was followed up from the date of surgery until August 2007. Cognitive function was assessed by a neuropsychological test battery at three time points: before, at 1 week after, and at 3 months after noncardiac surgery. Data on survival, labor market attachment, and social transfer payments were obtained from administrative databases. The Cox proportional hazards regression model was used to compute relative risk estimates for mortality and disability, and the relative prevalence of time on social transfer payments was assessed by Poisson regression. RESULTS: A total of 701 patients were followed up for a median of 8.5 yr (interquartile range, 5.3-11.4 yr). POCD at 3 months, but not at 1 week, was associated with increased mortality (hazard ratio, 1.63 [95% confidence interval, 1.11-2.38]; P = 0.01, adjusted for sex, age, and cancer). The risk of leaving the labor market prematurely because of disability or voluntary early retirement was higher among patients with 1-week POCD (hazard ratio, 2.26 [1.24-4.12]; P = 0.01). Patients with POCD at 1 week received social transfer payments for a longer proportion of observation time (prevalence ratio, 1.45 [1.03-2.04]; P = 0.03). CONCLUSIONS: Cognitive dysfunction after noncardiac surgery was associated with increased mortality, risk of leaving the labor market prematurely, and dependency on social transfer payments.",

author = "Jacob Steinmetz and Christensen, {Karl Bang} and Thomas Lund and Nicolai Lohse and Rasmussen, {Lars S} and {ISPOCD Group}",

note = "Keywords: Aged; Cognition Disorders; Cohort Studies; Female; Humans; Male; Middle Aged; Neuropsychological Tests; Postoperative Complications; Risk Factors; Time Factors",

year = "2009",

doi = "10.1097/ALN.0b013e318195b569",

language = "English",

volume = "110",

pages = "548--55",

journal = "Anesthesiology",

issn = "0003-3022",

publisher = "Lippincott Williams & Wilkins",

number = "3",

}

TY - JOUR

T1 - Long-term consequences of postoperative cognitive dysfunction

AU - Steinmetz, Jacob

AU - Christensen, Karl Bang

AU - Lund, Thomas

AU - Lohse, Nicolai

AU - Rasmussen, Lars S

AU - ISPOCD Group

N1 - Keywords: Aged; Cognition Disorders; Cohort Studies; Female; Humans; Male; Middle Aged; Neuropsychological Tests; Postoperative Complications; Risk Factors; Time Factors

PY - 2009

Y1 - 2009

N2 - BACKGROUND: Postoperative cognitive dysfunction (POCD) is common in elderly patients after noncardiac surgery, but the consequences are unknown. The authors' aim was to determine the effects of POCD on long-term prognosis. METHODS: This was an observational study of Danish patients enrolled in two multicenter studies of POCD between November 1994 and October 2000. The cohort was followed up from the date of surgery until August 2007. Cognitive function was assessed by a neuropsychological test battery at three time points: before, at 1 week after, and at 3 months after noncardiac surgery. Data on survival, labor market attachment, and social transfer payments were obtained from administrative databases. The Cox proportional hazards regression model was used to compute relative risk estimates for mortality and disability, and the relative prevalence of time on social transfer payments was assessed by Poisson regression. RESULTS: A total of 701 patients were followed up for a median of 8.5 yr (interquartile range, 5.3-11.4 yr). POCD at 3 months, but not at 1 week, was associated with increased mortality (hazard ratio, 1.63 [95% confidence interval, 1.11-2.38]; P = 0.01, adjusted for sex, age, and cancer). The risk of leaving the labor market prematurely because of disability or voluntary early retirement was higher among patients with 1-week POCD (hazard ratio, 2.26 [1.24-4.12]; P = 0.01). Patients with POCD at 1 week received social transfer payments for a longer proportion of observation time (prevalence ratio, 1.45 [1.03-2.04]; P = 0.03). CONCLUSIONS: Cognitive dysfunction after noncardiac surgery was associated with increased mortality, risk of leaving the labor market prematurely, and dependency on social transfer payments.

AB - BACKGROUND: Postoperative cognitive dysfunction (POCD) is common in elderly patients after noncardiac surgery, but the consequences are unknown. The authors' aim was to determine the effects of POCD on long-term prognosis. METHODS: This was an observational study of Danish patients enrolled in two multicenter studies of POCD between November 1994 and October 2000. The cohort was followed up from the date of surgery until August 2007. Cognitive function was assessed by a neuropsychological test battery at three time points: before, at 1 week after, and at 3 months after noncardiac surgery. Data on survival, labor market attachment, and social transfer payments were obtained from administrative databases. The Cox proportional hazards regression model was used to compute relative risk estimates for mortality and disability, and the relative prevalence of time on social transfer payments was assessed by Poisson regression. RESULTS: A total of 701 patients were followed up for a median of 8.5 yr (interquartile range, 5.3-11.4 yr). POCD at 3 months, but not at 1 week, was associated with increased mortality (hazard ratio, 1.63 [95% confidence interval, 1.11-2.38]; P = 0.01, adjusted for sex, age, and cancer). The risk of leaving the labor market prematurely because of disability or voluntary early retirement was higher among patients with 1-week POCD (hazard ratio, 2.26 [1.24-4.12]; P = 0.01). Patients with POCD at 1 week received social transfer payments for a longer proportion of observation time (prevalence ratio, 1.45 [1.03-2.04]; P = 0.03). CONCLUSIONS: Cognitive dysfunction after noncardiac surgery was associated with increased mortality, risk of leaving the labor market prematurely, and dependency on social transfer payments.

U2 - 10.1097/ALN.0b013e318195b569

DO - 10.1097/ALN.0b013e318195b569

M3 - Journal article

C2 - 19225398

SN - 0003-3022

VL - 110

SP - 548

EP - 555

JO - Anesthesiology

JF - Anesthesiology

IS - 3

ER -

Long-term consequences of postoperative cognitive dysfunction

Abstract

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