Factors Influencing Elderly Long-Term Postoperative Cognitive Dysfunction In Robot-Assisted Urological Surgery

ObjectivePerioperative neurocognitive disorders manifest a decline in learning,memory,attention and other functions,and are common surgical complications in elderly patients.Existing studies have focused on short-term follow-up of cognitive function during hospitalization,while long-term cognitive follow-up after robotic surgery is lacking.This study aims to clarify the incidence of long-term cognitive dysfunction in elderly patients undergoing robotic surgery,explore the risk factors affecting its occurrence and evaluate the predictive value,so as to provide a basis for perioperative brain protection measures in elderly patients.MethodsWe included elderly patients who underwent robotic-assisted urology surgery at Nanjing Drum Tower Hospital from August 2020 to July 2021 into the cohort and tracked their cognitive status one,three and six months after surgery.In addition,the electronic medical record system was consulted to collect information on patient demographic characteristics and clinical data,and patients were followed up for perioperative sleep,pain,anxiety,and depression.The influencing factors of long-term cognitive dysfunction in elderly patients were preliminarily explored through univariate analysis,and then the factors were included in the binary logistic regression model to obtain OR values and 95% confidence intervals,then evaluating the discrimination and calibration of predictive model.Further plotting the receiver operating characteristic curves yielded the sensitivity and specificity of the predictors.Results1.A total of 418 patients were included in the cohort,and finally,339 patients were fully statistically analyzed.The incidence of cognitive dysfunction in elderly patients undergoing robotic-assisted laparoscopic urology surgery in the first,third and sixth month after surgery was26.7%,19.9% and 14.3%,and the incidence of severe cognitive impairment was 6.2%,4.7% and4.4%,respectively.2.The risk factors for the development of p-NCD one month after surgery were the patient’s education years,the degree of pain during the first day of activity after surgery,and the protective factor was the cognitive status of the patient at discharge.The ORs and 95% CIs for years of education >12,postoperative MMSE score <27,and NRS pain score >2 on the first day of postoperative activity were 2.67(1.55,4.60),2.65(1.51,4.65),and 2.81(1.45,5.42),respectively.3.The area under the receiver operating characteristic curves for the patient’s years of education,postoperative MMSE score,and NRS pain score on the first day of postoperative activity were 0.627,0.611,and 0.619,respectively,and the area under the receiver operating characteristic curve was 0.733 for the age-corrected multifactor logistic regression model that included the above three predictors.4.Patients mainly showed a decline in memory after surgery,and baseline cognitive function before surgery was a predictor of cognitive function three months after surgery.Cognitive decline at one month after surgery positively correlated with cognitive dysfunction at three and six months postoperatively.ConclusionsElderly patients undergoing robotic-assisted laparoscopic urology surgery have long-term cognitive decline after surgery,satisfactory postoperative analgesia has a protective effect on brain function.Patients with high-level education are at higher risk of long-term cognitive dysfunction,and lower cognitive function at discharge is a warning for long-term cognitive decline.