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Postoperative Cognitive Dysfunction and the Change of Regional Cerebral Oxygen Saturation in Elderly Patients Undergoing Spinal Surgery

 Kim, Jeongmin  ;  Shim, Jae-Kwang  ;  Song, Jong Wook  ;  Kim, Eui-kyung  ;  Kwak, Young Lan 
 Anesthesia and Analgesia, Vol.123(2) : 436-444, 2016 
Journal Title
 Anesthesia and Analgesia 
Issue Date
Age Factors ; Aged ; Area Under Curve ; Cerebrovascular Circulation* ; Cognition* ; Cognition Disorders/diagnosis ; Cognition Disorders/etiology* ; Cognition Disorders/physiopathology ; Cognition Disorders/psychology ; Female ; Geriatric Assessment ; Humans ; Logistic Models ; Male ; Monitoring, Intraoperative/methods* ; Multivariate Analysis ; Neuropsychological Tests ; Odds Ratio ; Orthopedic Procedures/adverse effects* ; Oxygen/blood* ; Oxygen Consumption* ; Predictive Value of Tests ; Prospective Studies ; ROC Curve ; Risk Factors ; Spine/surgery* ; Time Factors ; Treatment Outcome
BACKGROUND: In this study, we examined the relationship between postoperative cognitive dysfunction (POCD) and intraoperative regional cerebral oxygen saturation (rSO2) in elderly patients undergoing spinal surgery. METHODS: We enrolled 87 patients older than 65 years. All patients were tested using a battery of cognitive function tests (Korean Mini-Mental State Examination and visuomotor test of Dynamic Lowenstein Occupational Therapy Cognitive Assessment-Geriatric Version) the day before their surgical operation and on the seventh postoperative day. Our threshold for defining POCD for a given patient was a Reliable Change Index score of <-1.96 occurring on 2 tests. RESULTS: POCD was detected in 20 patients (23%) at the seventh postoperative day. Between-patient baseline characteristics, surgical data, and baseline cognitive function were similar for both those who developed POCD and those who did not. A univariate analysis that included age, female sex, education level, presence of diabetes, and duration of intraoperative decline in rSO2 to a level of <60% of baseline revealed that only diabetes and duration of rSO2 <60% (odds ratio, 1.01; 95% confidence interval [CI], 1.005-1.010) were found to be risk factors for POCD. After multivariate logistic regression analysis of these 2 variables, only the duration of rSO2 <60% (odds ratio, 1.006; 95% CI, 1.00-1.01, P = 0.014) remained as an independent risk factor for POCD. The area under the receiver operation characteristic of the duration of rSO2 <60% was 0.70 (95% CI, 0.57-0.82; P = 0.008). The optimal cutoff value was 157 minutes with a sensitivity of 75% and specificity of 72%. CONCLUSIONS: This study showed that the duration of decline in rSO2 <60% during lumbar spinal surgery was correlated with the development of POCD at the seventh postoperative day in elderly patients.
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1. College of Medicine (의과대학) > Dept. of Anesthesiology and Pain Medicine (마취통증의학교실) > 1. Journal Papers
Yonsei Authors
곽영란(Kwak, Young Lan) ORCID logo https://orcid.org/0000-0002-2984-9927
김의경(Kim, Eui Kyung)
김정민(Kim, Jeongmin) ORCID logo https://orcid.org/0000-0002-0468-8012
송종욱(Song, Jong Wook) ORCID logo https://orcid.org/0000-0001-7518-2070
심재광(Shim, Jae Kwang) ORCID logo https://orcid.org/0000-0001-9093-9692
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