Cognitive recovery after general anesthesia is affected by many factors including age, gender, anesthetic technique, and duration of surgery. For reasons currently unknown, this phenomenon is best explained by cognitive heterogeneity.
Cognitive complications after surgery may be associated with an increased risk of postoperative depressive symptoms, confusion, and a shorter LOS in the hospital. These data also highlight the potential need for proactive screening, timely interventions, and early referral for medical therapy when symptomatic.
We did not find an association between postoperative cognitive complication and patient sex, age, ASA (American Society of Anesthesiologists) score at surgery and dementia after surgery. The major cause of postoperative psychiatric morbidity among patients who required re-admission for psychiatric disorders was a high baseline burden of mental health and psychiatric problems and chronic alcoholism.
POCD is highly prevalent after cardiac surgery and the risk of POCD increased in patients who had a low socioeconomic status. Surgical techniques, including neurocognitive assessments, could be useful to identify patients at high risk of POCD.
These data suggest that the majority of doctors do not use one of the recommended treatments listed herein for patients who suffer from postoperative cognitive complications. However, this may be due to difficulty in diagnosing and managing such patients. A few specialists have a good tendency to use these drugs, but not as frequently as other specialists. More doctors would be interested in learning these medications and methods and using them after seeing the patient. The use of different drugs and methods may be a good option to help those who suffer from postoperative cognitive complications.
The data indicate that POCCs, when present, are more common in patients who undergo non-elective cranial or spinal surgery versus non-elective procedures such as hernia surgery, and that the likelihood of occurrence is increased for surgical operations involving the posterior cranial fossa such as skull base and cerebellar procedures.
An increasing number of neuropsychiatric diagnoses occur in the first 14 postoperative days. Some research suggests this could be related to either procedural and/or perioperative pain.
Postoperative cognitive complications (POCD) negatively affect quality of life. Treatment is safe, effective, and can be performed at the bedside or outpatient setting. POCD can be improved by cognitive therapy or antidepressant treatment.
Despite the availability of studies demonstrating superiority of treatment over controls, no studies have reported the use of pharmacological treatments as treatment instead of a placebo in order to prove the superiority. A systematic review indicated that 'despite its limitations, the current findings do provide some support for pharmacological treatment to be beneficial. There is, however, little evidence that pharmacological intervention is more effective than a placebo'. In future studies, using pharmacological treatments and a placebo combined with a clinical assessment should be considered for assessing efficacy of pharmacological treatments.
[Only 20% of patients report being well-informed about their treatment options] Most patients reported being well informed about the treatment options available. There is no evidence that receiving information before surgery enhances post-operative recovery (PSA: 5.9 ± 2.8 vs. 4.9 ± 2.0; p = 0.07; VAS: 15.8 ± 7.9 vs. 16.5 ± 14.3; p = 0.90). More than half the patients (54%) reported receiving information from their multidisciplinary clinician, including information on post-operative complications. Patients reported receiving information from their clinician in the preceding 6 months had longer post-operative hospital recovery times (7.
A large proportion of patients undergoing abdominal hysterectomy will be screened for PCE in the days after surgery. This might help us identify specific patients at a higher risk of developing PCE, so that clinicians will be able to address some of the concerns related to the development of this complication in the postoperative period prior to surgery and therefore improve compliance with postoperative safety measures. Nevertheless, the primary cause of PCE is not fully understood.
A wide range of techniques have been investigated for alleviating these complications, yet it is not clear which might be the most effective when compared to the others. There is no evidence supporting or casting doubt on the efficacy of any one treatment technique.