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History of alcohol abuse after major non-cardiac surgery and postoperative cognitive dysfunction

      Abstract

      Introduction

      The risk factors for postoperative cognitive dysfunction (POCD) after non-cardiac surgery include advanced age and preexisting cognitive impairment.

      Material and methods

      Data was collected in a prospective manner on 220 patients of both genders. Patients were triaged into three groups, with American Society of Anesthesiologists—ASA Physical Classification System levels I–IV. Patients were 55 years of age and older, with self-reported alcohol abuse and were matched to age-, sex-, and education-matched nonalcoholic controls. They were tested using a neurocognitive battery before and two weeks after elective surgery or after a corresponding time interval without surgery. Verbal memory, visuospatial memory, and executive functions were assessed. Neurologic examination was performed in order to exclude subjects with potential cerebrovascular damage. Standard laboratory analyses were done and findings recorded. Significant predisposing factors for developing POCD were noted.

      Results

      From the total number of participants involved in the study, 135 (67.5%) patients belonged to ASA class III. Among all patients, 168 (84%) patients were chronic alcohol users. Pearson's χ2 test shows a statistically significant difference regarding the use of alcohol (χ2 = 19.220, df = 1, p = 0.000, p < 0.05). Significant three-way interactions (analysis of variance) for Visual Immediate Recall, Visual Delayed Recall, Semantic Fluency, Phonemic Fluency, and the Color-Word Stroop Test implied that cognitive performance in the alcoholic group decreased after surgery.

      Discussion

      In the study by Mason which involved 255 elderly patients that were postoperatively admitted to the intensive care unit following a major abdominal surgery, development of POCD was two times greater in urgent cases (~40% of cases), when compared to elective interventions.

      Conclusion

      Our results complement the data given by the World Health Organization and results of similar studies.

      Keywords

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      References

        • Yersin B.
        • Nicolet J.F.
        • Dercrey H.
        • Burnier M.
        • van Melle G.
        • Pécoud A.
        Screening for excessive alcohol drinking. Comparative value of carbohydrate-deficient transferrin, gamma-glutamyltransferase, and mean corpuscular volume.
        Arch Intern Med. 1995; 155: 1907-1911
        • Ovezov A.M.
        • Lobov M.A.
        • Panteleeva M.V.
        • Lugovoĭ A.V.
        • Miatchin P.S.
        • Gus'kov I.E.
        Correction of early cognitive disorders in school-age children operated under total intravenous anaesthesia.
        Anesteziol Reanimatol. 2012; 3: 25-29
        • Fesenko Ułbołgan A.
        Piracetam improves children's memory after general anaesthesia.
        Anaesthesiol Intensive Ther. 2009; XLI: 16-21
        • Mason S.E.
        • Noel-Storr A.
        • Ritchie C.W.
        The impact of general and regional anesthesia on the incidence of post-operative cognitive dysfunction and post-operative delirium: a systematic review with meta-analysis.
        J Alzheimers Dis. 2010; 22: 67-79
        • Hudetz J.A.
        • Iqbal Z.
        • Gandhi S.D.
        • Patterson K.M.
        • Hyde T.F.
        • Reddy D.M.
        • et al.
        Postoperative cognitive dysfunction in older patients with a history of alcohol abuse.
        Anesthesiology. 2007; 106: 423-430