Long-term Consequences of Postoperative Cognitive Dysfunction
Long-term Consequences of Postoperative Cognitive Dysfunction
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DOI：
10.1097/aln.0b013e318195b569
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发表时间：
2009-03-01
期刊：
影响因子：
8.8
通讯作者：
Rasmussen, Lars S.
中科院分区：
文献类型：
--
作者：
Steinmetz, Jacob;Christensen, Karl Bang;Rasmussen, Lars S.
背景：老年患者非心脏手术后常见术后认知功能障碍（POCD），但其后果尚不清楚。作者的目的是确定POCD对长期预后的影响。方法：这是一项观察性研究的丹麦患者参加了1994年11月和2000年10月之间的POCD的两个多中心研究。该队列从手术之日起随访至2007年8月。在非心脏手术前、手术后1周和手术后3个月的3个时间点，通过神经心理学成套测验评估认知功能。生存，劳动力市场附着和社会转移支付的数据来自行政数据库。考克斯比例风险回归模型被用来计算死亡率和残疾的相对风险估计，和社会转移支付的时间的相对患病率进行了评估Poisson regression.Results：共701例患者进行了随访，中位数为8.5年（四分位数间距，5.3-11.4年）。3个月时的POCD与死亡率增加相关，而1周时与死亡率增加无关（风险比为1.63 [950%置信区间为1.11-2.38]; P = 0.01，经性别、年龄和癌症校正）。POCD 1周患者因残疾或自愿提前退休而过早离开劳动力市场的风险较高（风险比，2.26 [1.24-4.12]; P = 0.01）。POCD患者在1周内接受社会转移支付的比例较长的观察时间（患病率比，1.45 [1.03-2.04]; P = 0.03）。结论：非心脏手术后认知功能障碍与死亡率增加，过早离开劳动力市场的风险和对社会转移支付的依赖有关。
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 data-bases. 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 [950% 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.