Consciousness and behavioral disorders, confusion, even delusions, hallucinations… Postoperative delirium (POD) is a frequent complication in the days following surgery, particularly in the elderly. But this temporary state, often worrying for loved ones, could have longer-term consequences at the cerebral level. A american studypublished on March 20 in the journal JAMA Internal Medicinethus shows that the occurrence of postoperative delirium is associated with a 40% acceleration of cognitive decline in the following six years. “Being an observational study, we cannot know if it is postoperative delirium that leads to cognitive decline or if patients with pre-existing brain damage are more likely to develop this complication”conclude, cautious, Zachary Kunicki (Brown University, Providence, Rhode Island), first author of the article, and his colleagues.
The researchers included 560 patients (including 58% women), participating in a cohort of subjects over the age of 70 followed after surgery. Before the operation and regularly afterwards, these volunteers were subjected to a complete cognitive evaluation by a battery of eleven neuropsychological tests. Among them, 134 (i.e. 24%) presented with postoperative delirium. In this group, the average age is slightly higher than in that of patients who did not suffer this complication, and their baseline cognitive scores are somewhat lower. But it is above all over time that the gap widens, with six years of hindsight: the slope of cognitive decline is much steeper in the group that had postoperative delirium than in the other, “on the order of that observed in people who have been diagnosed with Alzheimer’s disease within five years”the authors point out.
“An independent factor of morbidity and mortality”
After adjusting the parameters, they consider that cognitive decline is accelerated by 40% after POD, compared to normal aging. Further studies will be needed to determine whether the association is causal or whether delirium is primarily a marker of susceptibility. In the meantime, these results argue for the prevention of this complication in elderly subjects undergoing surgery.
In its latest update on the subject, dated November 2019, the French Society of Anesthesia and Resuscitation lists the POD prevention and management measures. According to the learned society, this complication is “an independent factor of morbidity and mortality, prolonged hospitalization and long-term cognitive and/or functional disorders, themselves the cause of dependence and significant social and financial costs”.
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