The Influence Of Endoscopic And Robotic Surgery On Postoperative Cognitive Dysfunction And Related Factors In Elderly Patients

Objective Postoperative cognitive dysfunction(POCD)is a common postoperative central nervous system complication,manifested as perception,memory and thinking disorder,characterized by impaired memory,reduced visual space,execution,and computational power.The incidence of POCD is as high as 3-61%,and 50% of surgical patients over 60 years of age can develop cognitive dysfunction.The cardiac surgery POCD even lasts for several months.Postoperative cognitive dysfunction leads to increased hospitalization time and medical expenses,and can develop into brain organic disease in the long term.More serious can lead to increased perioperative mortality and complications,which greatly affects the quality of life and threatens life.Studies at home and abroad have shown that the occurrence of POCD may be related to the age,type of surgery,underlying diseases,anesthetic drugs,and excessive operation time.Due to the lack of a unified literature,further research is still needed.Minimally invasive surgery is the general trend and goal of surgical development.At present,the most common minimally invasive procedures include laparoscopic surgery and Da Vinci robotic surgery.Among them,laparoscopic surgery has the advantages of less trauma and quick recovery than traditional surgery.Robotic surgery has less trauma,clearer vision and postoperative operation than laparoscopic surgery.Recovery and other advantages.However,the relationship between minimally invasive surgery and POCD has not been elucidated,especially the incidence of POCD and the influencing factors in elderly patients with robotic surgery have not been reported.This study aimed to investigate the occurrence and related factors of POCD in laparoscopic surgery and robotic surgery in elderly patients.Methods(1)Review of 80 elderly patients undergoing elective laparoscopic cholecystectomy during the period from September 4,2017 to November 30,2018,Gansu Provincial People’s Hospital;(2)elderly patients with endoscopic or robotic chest and abdomen non-cardiac surgery 323 cases and 150 cases,age ≥ 60 years,gender is not limited,ASA grade I ~ II,BMI 18.5 ~ 23.9.The neuropsychological test was used to comprehensively evaluate the cognitive function of the patients.According to whether or not POCD occurred within 30 days after surgery,patients with(1)-laparoscopic cholecystectomy were divided into non-POCD group and POCD group.(2)Patients in laparoscopic surgery group and robotic surgery Group patients were divided into non-POCD group and POCD group.Record the general factors,intraoperative indicators,postoperative recovery and other possible factors.Univariate and multivariate logistic regression analysis were used to screen out the relevant factors of POCD in laparoscopic surgery or robotic surgery.Results(1)The incidence of POCD in laparoscopic cholecystectomy in elderly patients was23.75%.Logistic regression analysis showed that patients had poor sleep quality(OR=27.2),VAS score >4 points(OR=6.7)on the first postoperative day,and low oxygen saturation(OR=1.505)on the first postoperative day.On the third day,the VAS score was >3(OR=7.78),which was the related factor of POCD in laparoscopic cholecystectomy in elderly patients(P<0.05).(2)The incidence of POCD occurred in 73 patients in 2 laparoscopic group,the incidence rate was 22.6%.POCD occurred in 27 patients after the robot group,and the incidence rate was 18.0%.There was no difference in the incidence of POCD between the two groups.Logistic regression analysis showed that patients with hypertension >12 years(OR=1.088),poor sleep quality(OR=3.397),intraoperative hemoglobin <90g/L(OR=1.842),and white blood cell count on the third day after surgery >13.8×109/L(OR=1.241)was a relevant factor for POCD in elderly patients after laparoscopic surgery(P<0.05).Patients with poor sleep quality(OR=17.158),VAS score >6(OR=9.821)on day 1 postoperative,VAS score >5 on day 3(OR=6.652),VAS score on day 7 >3(OR =6.965)The factors associated with POCD in elderly patients after surgery(P<0.05).Conclusion(1)Patients with poor sleep quality,moderate to severe postoperative pain and low early oxygen saturation are independent risk factors for POCD in laparoscopic cholecystectomy;(2)laparoscopic and robotic chest and abdomen non-cardiac surgery leads to risk factors for POCD different.Poor sleep quality is a common risk factor for POCD in elderly patients after laparoscopic and robotic surgery.Clinical trials have shown no difference in POCD between laparoscopic and robotic surgery.