| Objective Postoperative cognitive dysfunction(POCD)refers to short-term or long-term cognitive decline that can be detected through a battery of neuropsychological tests after surgery.POCD can be considered a mild cognitive disorder characterized by impaired memory,learning difficulties,and a reduced ability to concentrate.The occurrence of cognitive dysfunction is correlated with multiple adverse effects,such as increased healthcare costs,a prolonged hospital stay and a high mortality rate.However,the mechanism of POCD remains poorly understood and the prevention of POCD remains a serious problem,particularly in patients of advanced age.Previous studies have been controversial about the relationship between smoking and POCD in elderly patients.Studies have shown that cholinergic anti-inflammatory pathways help reduce the risk of POCD and nicotine in cigarettes may stimulates the cholinergic anti-inflammatory pathway.We investigated whether patients of advanced age with a preoperative smoking history have a decreased risk of POCD.Methods This is a prospective cohort study,also an observational study.Patients aged>60 years who underwent general anesthesia for noncardiac surgery were enrolled.There were excluding criteria of this research:underwent cardiac surgery or neurosurgery,had stopped smoking for more than 1 year,had a previous diagnosis of a mental or nervous system disease,had a preoperative Mini-Mental State Examination score confirming the existence of cognitive impairment(<17 points for illiteracy;<20 points for primary school;<24 points for senior high school or above),were currently using antipsychotic or antidepressant medications,were unable to communicate or experienced difficultly in communicating with language,had severe hypotension or hypoxemia for more than 10 minutes during surgery,were sent to the Intensive Care Unit after surgery,and who did not willing to take part in this research.382 cases were enrolled finally,including 190 people with a history of smoking,192 people without a history of smoking.Informed consent was signed for each patient or their families and each patient's cognitive function was assessed 1 day preoperatively and 5 and 7 days postoperatively.The following data were also collected:patient education level,age,weight,type of surgery,chronic diseases,allergy history,preoperative hematocrit and albumin level,history of general anesthesia for surgery,anesthesia duration,sufentanil dosage,intraoperative maximum lactate concentration,requirement for blood transfusion,duration of hospital stay and preoperative smoking history.Besides,blood samples were obtained 1 day preoperatively and 5 and 7 days postoperatively.Multivariate logistic regression analysis was performed to identify possible risk factors.ResultsOn postoperative days 5 and 7,111(29.05%)and 90(23.56%)patients exhibited POCD,respectively.A preoperative smoking history was significantly correlated with a decreased risk of early POCD(P=0.009),and a high serum tumor necrosis factor-a(TNF-a)level on the postoperative days 5 and 7 was significantly associated with an increased risk of POCD(P=0.042,P=0.027).Early POCD was meaningfully correlated with the sufentanil dosage,age,and education level.The hospital stay in patients with and without POCD was 10.54±2.03 and 8.33±1.58 days,respectively.ConclusionOn the basis of the results of our study a preoperative smoking history is associated with a decreased risk of early POCD by stimulating the cholinergic anti-inflammatory pathway,and a high level of serum TNF-a was meaningfully correlated with an increased risk of early POCD.Age,a history of general anesthesia,the sufentanil dosage,a lower education level,and the anesthesia duration are independent risk factors for POCD.Finally,early POCD prolongs the hospital stay. |
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