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 "Our data suggest that, on average, major surgery is associated with
only a small cognitive 'hit,'" said Dr. Robert Sanders, an assistant
professor in the department of anesthesiology at the University of
Wisconsin, Madison, and the study's senior author. "And while there
was a doubling in the risk of substantial cognitive decline, this
only affected a small number of patients. Nonetheless, this small
potential for harm should still be considered when weighing the
proposed health benefits of surgery during informed consent."
Sanders and his colleagues decided to do the study because they
feared some patients might be skipping surgeries out of concern it
could impact their cognitive functioning afterward. "For 60 years a
major concern has been that surgery might . . . drive long term
changes in cognition," the researchers write. "Our recent survey
suggested that 65% of the public are concerned about postoperative
deficits."
To take a closer look at how large such harm might be, the
researchers turned to data from the Whitehall II study, which has
followed more than 10,000 British civil service workers since the
late 1980s when they were between the ages of 35 and 55. A decade
into the study, participants were asked to take a battery of
cognitive tests, which were repeated up to four times over the next
10 to 20 years.
As reported in The BMJ, the researchers focused on 7,532
participants with at least one cognitive assessment. Of these, 1,250
were admitted to the hospital for a major surgery - defined as a
procedure that required a stay of at least two nights – between
their first and last cognitive tests. There were also 715 people
admitted for more than two nights for major non-surgical illnesses,
including strokes.
After accounting for trajectories of age-related cognitive decline
in participants before hospitalization, the researchers calculated
that major surgery was associated with a small additional decline
equivalent to a little over four months of natural cognitive aging.
In contrast, non-surgical major hospital admissions were tied to the
equivalent of 1.4 years of aging, and strokes in particular incurred
the equivalent of 13 years of aging.
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In 5.5% of surgical patients as well as 12.7% with major nonsurgical
admissions, there was a more substantial cognitive decline following
hospitalization. But 2.5% of participants who had no hospital
admissions also experienced substantial cognitive declines. Compared
to them, the researchers calculated, the risk of substantial
cognitive decline was 2.3 times greater with major surgery.
The researchers don't know exactly why there was a decline in
cognition in the participants who had surgery. "It's widely
considered that anesthesia may affect long-term cognition, but this
has not been strongly supported by the recent literature," Sanders
said in an email.
The new report offers "good news and bad news," said Sandra
Weintraub, a professor and clinical core director at the Mesulam
Center for Cognitive Neurology and Alzheimer's Disease at
Northwestern University's Feinberg School of Medicine in Chicago.
The good news, is that for most people the decline "wasn't that
great," Weintraub noted.
"Having said that, it really puts patients between a rock and a hard
place if they're told they need surgery and worry about losing
mental function," Weintraub said. "I'd like to see physicians take
on a little more responsibility in helping make the risks clearer."
Even better, Weintraub added, would be cognitive testing prior to
surgery because the impact on the brain might be worse in patients
who already are developing a brain disease such as Alzheimer's but
currently only have subtle symptoms.
"I would probably want to know what my mental function was prior to
going in to surgery," she added. "You don't know if you are at risk
if you've never had your memory measured."
SOURCE: https://bit.ly/2NtjUjV The BMJ, online August 7, 2019.
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