Cognitive Impairment After Minimally Invasive Surgery In The Elderly

Backgroud:Postoperative cognitive dysfunction (POCD) commonly occurs after cardiac surgery in the elderly. A recent 10 years study has suggested a higher incidence after non-cardiac surgery. But the consequences are unknown. With the social development, surgery technique was greatly improved. More older patients choose minimally invasive surgery because it have an advantage of short time and little trauma. Most older patients can bear a beat intraoperative. The authors'aim was to observe the incidence and risk factors for POCD on short-term prognosis after minimally invasive surgery.Obejiective:The aim of the present study was to investigate the incidence and main risk factors for POCD in elderly patients after minimally invasive surgeryMethods:We elected 354 older patients undergoing minimally invasive surgery,including the surgeries of laparoscopic cholecystetomy, transurethral resection of prostate, percutaneous nephrolithotomy, transurethral resection of bladder tumor, transurethral ureteroscopy surgery. Eligible patients for study were 60 years and over undergoing minimally invasive surgery. Exclusion criteria were diseases of cognitive impairment preoperatively, Criitically ill patients, ASA>Ⅲgrade, Mental illness. We recorded every patient's general medical history preoperatively, Patients' general information:sex, age, history of hypertension, history of diabetes, history of alcohol and smoking, Lab abnormalities were recorded. After giving written informed consent, patients were randomly allocated to general or regional anaesthesia. We recorded the amount of bleeding, hypotension times, operating time. Cognitive function was assessed using Mini—Mental State Examinatlon (MMSE) undertaken preoperatively 1 day,1 day and 3 days after operation. We recorded MMSE-Scorse and analgesia after surgery. POCD is defined by illiteracy<17, primary education< 20, secondary education<24scores as criteria. Cognitive impairment was defined as a composite MMSE-score> 2.Results:304 patients than 60 years old undergoing minimally invasive surgery were studied. POCD presented in 11 of 304 patients(3.6%) 1 day after surgery. POCD presented in 8 of 304 patients (2.6%) 3 day after surgery,Cognitive decline presented in 44.7% 1 day and 23.4% 3day.We found that it was risk factors for POCD with age (P=0.001) and a history of hypertention (P=0.005) in 1st day. Surgery type (P=0.026) and way (P=0.013) was a risk factor of POCD in 3rd day. A history of alcohol (P=0.087) and educated (P=0.053) had the effect on POCD in 3rd day, but there is no significance. MMSE scores revealed the difference in education (P=0.001) had an apparent influence on cognitive and memory in 1 st day. Secondary education (P=0.027) had little influence on cognitive and memory in 3rd day. There were significant differences. Logistic regression analysis show that hypertension (P=0.008) and secondary education (P=0.026) were the risk factors for postoperative cognitive dysfunction for 1st day after operative. Illiteracy (P=0.000), Secondary education (P=0.000),diabetes (P=0.019),history of operation (P=0.021) were the risk factors for cognitive and memory impairment in the 3st day. POCD is correlate closely with cognitive and memory impairment (P<0.05)Conclusion:The elderly have a lower incidence of POCD after minimally invasive surgery, but have a higher incidence of cognitive and memory impairment. As time goes, Patients have a tendency of gradual recovery.Older age,history of hypertention and educational level are risk factors of early POCD. It has a correlation between cognitive impairment and memory decline.