Incidence of postoperative cognitive dysfunction in older women undergoing pelvic organ prolapse surgery
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ORIGINAL ARTICLE
Incidence of postoperative cognitive dysfunction in older women undergoing pelvic organ prolapse surgery Mary F. Ackenbom 1,2 & Meryl A. Butters 3 Halina M. Zyczynski 1,2
&
Esa M. Davis 4 & Kaleab Z. Abebe 4,5 & Lindsey Baranski 2 &
Received: 18 June 2020 / Accepted: 13 August 2020 # The International Urogynecological Association 2020
Abstract Introduction and hypothesis Postoperative cognitive dysfunction (POCD), a transient impairment of memory, concentration, and information processing, has been reported after 7–26% of non-cardiac surgeries with associated increase in morbidity and death. Our primary aim was to determine the incidence of POCD 2 weeks after prolapse surgery in women ≥ 60 years old. Our secondary aim was to identify risk factors for POCD. Methods Prospective cohort study of women ≥ 60 years old scheduled for pelvic organ prolapse surgery. Exclusion criteria included cognitive impairment history, major neurologic disorder, and abnormal cognition screen. A comprehensive neuropsychologic (NP) battery (eight tests), administered 2 weeks pre- and post-surgery, assessed premorbid IQ and domains of attention, memory, and executive function. The primary outcome was defined as decline of ≥ 1 SD on ≥ 2 NP tests or decline of ≥ 2 SD on ≥ 1 test. Raw scores were transformed to Z-scores. Results NP testing was completed by 72 women, median age 72 (IQR 69–77) years. Procedures included 16 (22.9%) laparoscopic sacrocolpopexies, 23 (32.9%) transvaginal reconstructions, and 29 (41.4%) obliterative surgeries, performed under general (63, 90%), regional (5, 7.1%), or sedation (2, 2.9%) anesthesia with a median hospital stay of 0.6 (IQR 0.6–0.75) days. POCD incidence was 33.3% (n = 24). POCD was associated with greater frailty (p = 0.006) and higher baseline depression (p = 0.05) but not with older age (p = 0.77) or inhalational gas use (p = 1.0). Conclusion In this cohort, one in three women manifested POCD 2 weeks after prolapse surgery. Preoperative counseling should include discussions on POCD given its detrimental impact on postoperative recovery and independence. Keywords Cognitive decline . Older women . Perioperative neurocognitive disorders . Pelvic organ prolapse surgery . Postoperative cognitive dysfunction . Urogynecologic surgery
Introduction * Meryl A. Butters [email protected] 1
Division of Urogynecology and Pelvic Reconstructive Surgery, Magee Womens Research Institute and Foundation, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
2
Division of Urogynecology and Pelvic Reconstructive Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
3
Department of Psychiatry, UPMC Western Psychiatric Hospital, 3811 O’Hara St., Pittsburgh, PA 15213, USA
4
Department of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
5
University of Pittsburgh Center for Research on Health Care Data Center, Pittsburgh, PA, USA
Postoperative cognitive dysfunction (POCD) is primarily a transient deterioration of cognition a
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