Major Surgery Linked to Lasting Change in Cognitive Trajectory

Major surgery is associated with a small, long-term change in the average cognitive trajectory, according to a study published online in The BMJ.

Bryan M. Krause, Ph.D., from the University of Wisconsin in Madison, and colleagues conducted a prospective longitudinal cohort study involving 7,532 adults with up to five cognitive assessments between 1997 and 2016 in the Whitehall II study with linkage to data on hospital episodes.

The researchers found that major surgery correlated with a small additional cognitive decline after accounting for the age-related cognitive trajectory, which was equivalent to an average of less than five months of aging (95 percent credible interval, 0.01 to 0.73 years). Admissions for medical conditions and stroke correlated with 1.4 (95 percent credible interval, 1.0 to 1.8) and 13 (95 percent credible interval, 9.6 to 16) years of aging. Substantial cognitive decline occurred in 2.5, 5.5, and 12.7 percent of patients with no admissions, surgical admissions, and medical admissions, respectively. Participants with surgical or medical events were more likely to have substantial decline from their projected trajectory compared to those with no major hospital admissions (odds ratios, 2.3 [95 percent credible interval, 1.4 to 3.9] and 6.2 [95 percent credible interval, 3.4 to 11.0] for surgical and medical admissions, respectively).

"This information should be conveyed to patients and be weighed against the potential health and quality of life benefits of surgery during informed consent discussions with patients," the authors write.

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