Plasma albumin and other indicators as risk factors for delayed neurocognitive recovery in elderly patients undergoing orthopedic surgery.

BACKGROUND

The risk factors for neurocognitive impairment outcomes vary among different types of surgeries. The risk factors for delayed neurocognitive recovery (DNR) in elderly patients following orthopedic surgery are unclear. The objective of this study was to identify the risk factors for early postoperative delayed neurocognitive recovery in elderly patients who underwent elective orthopedic surgery.

METHODS

The medical data of 166 elderly patients underwent elective orthopedic procedures were analyzed retrospectively. The cognitive scores on the day before the surgery and on the 7th postoperative day were assessed using the MoCA scale, and Z-scores were utilized to account for learning effects. The study population was divided into two groups according to whether DNR occurred by the 7th postoperative day or prior to discharge. Risk factors associated with postoperative DNR in elderly orthopedic patients were determined using logistic regression analysis.

RESULTS

There were 166 elderly surgical patients, with an incidence rate of 28.9% DNR. Multivariate logistic regression analysis revealed that a history of drinking (OR = 6.853 [1.825-25.734], P = 0.004), cerebrovascular stenosis (mild: OR = 7.646 [1.432-40.833], P = 0.017; moderate or severe: OR = 5.593 [1.222-25.607], P = 0.027), a preoperative PaO2/FiO2 ratio of < 350 (OR = 2.549 [1.045-6.219], P = 0.040), and postoperative albumin levels of < 35 g/L (OR = 4.214 [1.489-11.923], P = 0.007) were independently associated with DNR on postoperative day 7. Furthermore, plasma albumin levels on postoperative day 1 showed a negative correlation with plasma interleukin 6 levels on postoperative day 3 (r = - 0.251, P = 0.006).

CONCLUSION

Early DNR in elderly orthopedic patients appears to be associated with multiple factors, including a history of drinking, cerebrovascular stenosis, a preoperative PaO₂/FiO₂ ratio < 350, and postoperative albumin < 35 g/L.