Duration of Surgery and Intraoperative Blood Pressure Management are Modifiable Risk Factors for Postoperative Neurocognitive Disorders Following Spine Surgery
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Study Design.Prospective quasi-experimental observational studyObjective.To evaluate whether duration of surgery is a modifiable risk factor for postoperative delirium (POD) following spine surgery, and explore further modifiable risk factors. Additionally, we sought to investigate the association between POD and postoperative cognitive dysfunction (POCD) and persistent neurocognitive disorders (pNCD).Summary of Background Data.Advances in spine surgery enable technically safe interventions in elderly patients with disabling spine disease. The occurrence of POD and delayed neurocognitive complications (e.g. POCD/pNCD) remain a concern, since these contribute to inferior functional outcomes and long-term care dependency following spine surgery.Methods.This prospective single-center study recruited patients aged ≥60 years and scheduled for elective spine surgery between 02/2018-03/2020. Functional (Barthel Index, BI) and cognitive outcomes (CERAD test battery; telephone MoCA) were assessed at baseline, three (V3) and twelve months postoperatively. The primary hypothesis was that duration of surgery predicts POD. Multivariable predictive models of POD included surgical and anesthesiological parameters.Results.Twenty-two percent of patients developed POD (n=22/99). In a multivariable model, duration of surgery (ORadj=1.61/hour [95%CI:1.20-2.30]), age (ORadj=1.22/year [95%CI:1.10-1.36]), and baseline deviations of intraoperative systolic blood pressure (25th percentile: ORadj=0.94/mmHg [95%CI:0.89-0.99]; 90th percentile: ORadj=1.07/mmHg [95%CI:1.01-1.14]) were significantly associated with POD. Postoperative cognitive scores generally improved (V3, ΔCERAD total z-score: 0.22±0.63). However, this positive group effect was counteracted by POD (beta:-0.87 [95%CI:−1.31--0.42]), older age (beta:−0.03/year [95%CI:−0.05--0.01]), and lack of functional improvement (ΔBI; beta:−0.04/point [95%CI:−0.06--0.02]). Cognitive scores at twelve months remained inferior in the POD group, adjusted for baseline cognition/age.Conclusions.This study identified distinct neurocognitive effects following spine surgery, which are influenced by perioperative risk factors. Potential cognitive benefits are counteracted by POD, rendering its prevention critical in an aging population.
