The Co-TELE-SURGE study: A prospective cohort proof-of-concept study of perioperative cognitive trajectories in older adults undergoing noncardiac surgery.
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Khaled Maram, Gutschon Rachel, Bathini Varunkumar, Martin Paul, Elmansy Hazem, Devereaux P J, Tiboni Maria, Harlock John, Cenic Aleksa, Sne Niv, Shargall Yaron, Nenshi Rahima, Shanthanna Harsha, Thabane Lehana, Germini Federico, Korstensky Michael, Grami Neeloufar, Selznick Asher, van Dyk Colette, Latchupatula Lekhini, Benayon Myles, Cotovio Anabela, Hoffman Allisson, Hircock Caroline, Yaremko Hannah, Chan Olsen, Dennis Michael, Blasioli Emanuele, Sabac Denise, Sharma Annika, Krysiak Kevin, Huan Peter, Gupta Shyla, Borges Flavia K, Ofori Sandra, Maiorano Silvia, Barisone Michela, Roldan Yetiani, Sevestre Michael, Ferber Mary, Mulazzani Francesca, Spence Jessica, Violette Philippe D, Marcucci Maura
Аннотация
OBJECTIVE: To explore the impact of surgery on perioperative cognitive trajectories, among ≥65 years old patients waiting for ≥6 weeks before undergoing elective noncardiac surgery during the COVID-19 pandemic.
METHODS: In this proof-of-concept prospective study, cognitive performance of participants was assessed remotely at enrolment, monthly preoperatively (≥2 assessments) and at 1, 3, 6, and 12 months postoperatively, using the Cogstate Brief Battery. The association of surgery with cognitive changes was analyzed using an interrupted time-series approach.
RESULTS: In the 84 included participants, after controlling for the preoperative trend, surgery resulted in a small decline in the level of average performance on tasks assessing psychomotor function and attention from before to after surgery (p = 0.017). Postoperative trajectories showed improvement compared to preoperative ones in the psychomotor function (p = 0.008), attention (p = 0.002) and visual learning (p = 0.007). After adjusting for potential confounders, only the postoperative level change in attention remained statistically significant (p = 0.027).
CONCLUSION: In our exploratory proof-of-concept study, surgery was associated with a statistically significant level and trend change in cognitive performance, however the magnitude of the change was small and partially due to confounding. Further research with adequate power is needed to confirm our findings and elucidate factors associated with postoperative cognitive decline.
REGISTRATION: clinicaltrials.govNCT04787536.