Lori A. Daiello, Pharm.D., Sc.M.; Annie M. Racine, Ph.D.; Ray Yun Gou, Ph.D.; Edward R. Marcantonio, M.D.; Zhongcong Xie, M.D., Ph.D.; et al
Anesthesiology 9 2019, Vol.131, 477-491.
Older adults represent a large and increasing proportion of surgical patients in the United States; although adults 65 yr and older comprised only 14% of the general population in 2014, they underwent more than one-third of all inpatient surgical procedures.1,2 Advances in surgical and anesthesia techniques, coupled with better preoperative risk assessment, have resulted in safer operations and lower rates of some serious complications (e.g., infections)3 ; however, much less is known about effectively safeguarding the aging brain from perioperative stress.
Perioperative disturbances of cognition may occur acutely, in the form of postoperative delirium,4 or after hospital discharge, as postoperative cognitive dysfunction.5 The incidence of postoperative delirium is 20 to 45% among older adult surgery patients4,6 ; postoperative cognitive dysfunction is experienced by 20 to 50% of older patients three months after cardiac surgery7,8 and in 5 to 55% of those undergoing other major surgeries.9,10 In general, higher rates have been reported in studies that defined postoperative cognitive dysfunction using less stringent statistical thresholds, and conversely, studies using more stringent statistical methods have found lower rates of postoperative cognitive dysfunction. This point is nontrivial because unlike delirium, postoperative cognitive dysfunction is not a clinical diagnosis but rather a variably operationalized concept defined by decline in postoperative cognitive performance as measured by a neuropsychologic tests. Read More