Post-Operative Neuropsychiatric Disorder

Editors

Chun Yang

First Affiliated Hospital, Nanjing Medical University

Yiying Zhang

Massachusetts General Hospital, Harvard Medical School

Jie Sun

Zhongda Hospital, Southeast University

Yasushi Satoh

National Defense Medical College (Japan)

Diansan Su

Renji Hospital, School of Medicine, Shanghai Jiao Tong University

Impact

$Orthogeriatric comprehensive care in geriatric patients with hip fractures for management of postoperative complication.$

Review

22 December 2022

Postoperative delirium in geriatric patients with hip fractures

Yang Chen

, 5 more and

Jun Li

Postoperative delirium (POD) is a frequent complication in geriatric patients with hip fractures, which is linked to poorer functional recovery, longer hospital stays, and higher short-and long-term mortality. Patients with increased age, preoperative cognitive impairment, comorbidities, perioperative polypharmacy, and delayed surgery are more prone to develop POD after hip fracture surgery. In this narrative review, we outlined the latest findings on postoperative delirium in geriatric patients with hip fractures, focusing on its pathophysiology, diagnosis, prevention, and treatment. Perioperative risk prediction, avoidance of certain medications, and orthogeriatric comprehensive care are all examples of effective interventions. Choices of anesthesia technique may not be associated with a significant difference in the incidence of postoperative delirium in geriatric patients with hip fractures. There are few pharmaceutical measures available for POD treatment. Dexmedetomidine and multimodal analgesia may be effective for managing postoperative delirium, and adverse complications should be considered when using antipsychotics. In conclusion, perioperative risk intervention based on orthogeriatric comprehensive care is the most effective strategy for preventing postoperative delirium in geriatric patients with hip fractures.

12,581 views

5 citations

Comparison of postoperative MMSE scores among the three groups.

Original Research

14 September 2022

Effects of different levels of controlled hypotension on regional cerebral oxygen saturation and postoperative cognitive function in patients undergoing total knee arthroplasty

Yajuan Zhao

, 5 more and

Bao Lang

2,138 views

6 citations

Differences in the right hippocampal connectivity between patients with ruptured ACoA aneurysm and healthy controls. Compared with the control group, brain regions labeling with color indicate decreased (upper panel) or increased functional connectivity (lower panel) in patients with ruptured ACoA aneurysm. Results were displayed in 2D (A,C) and 3D (B,D), respectively. The displaying threshold was set to p < 0.05, false discovery rate corrected, and cluster size >50. Details of abnormal connectivity regions are shown in Table 2. ACoA, anterior communicating artery.

Original Research

07 November 2022

Altered hippocampal functional connectivity after the rupture of anterior communicating artery aneurysm

Fuxiang Chen

, 8 more and

Dezhi Kang

1,549 views

2 citations

General Commentary

09 September 2022

Response: Commentary: Preoperative status of gut microbiota predicts postoperative delirium in patients with gastric cancer

Hu Liu

and

Xue-sheng Liu

1,160 views

1 citations

General Commentary

28 October 2022

Commentary: Correlation analysis of serum vitamin D levels and post-operative cognitive disorder in elderly patients with gastrointestinal tumor

Nikhil Ravindranath Tondehal

, 7 more and

Shailesh Jain

1,046 views

0 citations

Original Research

17 August 2022

The Age-adjusted Charlson Comorbidity Index predicts post-operative delirium in the elderly following thoracic and abdominal surgery: A prospective observational cohort study

Jing Liu

, 4 more and

Junfang Rong

4,241 views

19 citations

Clinical Trial

31 August 2022

Flurbiprofen used in one-lung ventilation improves intraoperative regional cerebral oxygen saturation and reduces the incidence of postoperative delirium

Liang Shen

, 5 more and

Di Wang

2,112 views

11 citations

Systematic Review

03 August 2022

Risk factors for postoperative delirium in geriatric patients with hip fracture: A systematic review and meta-analysis

Yi-ming Qi

, 4 more and

Yun-feng Rui

Objectives: This systematic review and meta-analysis was conducted to identify the potential risk factors for postoperative delirium in geriatric patients with hip fracture.

Methods: PubMed, EMBASE, and Cochrane Library were searched from inception until December 31st, 2021. A combined searching strategy of subject words and free words was adopted. Studies involving risk factors for postoperative delirium in elderly patients undergoing hip fracture surgeries were reviewed. Qualities of included studies were assessed using the Newcastle–Ottawa Scale. Data were pooled and a meta-analysis was performed using Review Manager 5.3.

Results: A total of 37 studies were included. The following risk factors were significant: advanced age (per year increase) (OR: 1.05, 95% CI 1.04–1.07), age>80 years (OR: 2.26, 95% CI 1.47–3.47), male (OR: 1.53, 95% CI 1.37–1.70), preoperative cognitive impairment (OR:3.20, 95% CI 2.12–4.83), preoperative dementia (OR: 2.74, 95% CI 2.18–3.45), preoperative delirium (OR: 9.23, 95% CI 8.26–10.32), diabetes (OR: 1.18, 95% CI 1.05–1.33), preoperative functional dependence (OR: 1.31, 95% CI 1.11–1.56), ASA level (per level increase) (OR: 1.63, 95% CI 1.04–2.57), ASA level≥3(OR: 1.76, 95% CI 1.39–2.24), low albumin (OR: 3.30, 95% CI 1.44–7.55), medical comorbidities (OR: 1.15, 95% CI 1.06–1.25), Parkinson's disease (OR: 4.17, 95% CI 1.68–10.31) and surgery delay>48 h (OR: 1.90, 95% CI 1.36–2.65).

Conclusions: Clinicians should be alert to patients with those risk factors. To identify the risk factors more precisely, more research studies with larger sample size and better design should be conducted.

5,393 views

25 citations

Original Research

15 April 2022

Correlation Analysis of Serum Vitamin D Levels and Postoperative Cognitive Disorder in Elderly Patients With Gastrointestinal Tumor

Jialei Zhang

, 3 more and

Yonghao Yu

Purpose: Vitamin D prevents hypocalcaemia, osteoporosis, and infections, among other problems, and is involved in the prevention and treatment of cardiovascular and neurological diseases. Recently, vitamin D was shown to improve cognitive dysfunction caused by Alzheimer's disease and vascular dementia. This study aims to explore the correlation between preoperative serum vitamin D and postoperative cognitive disorder (POCD) occurrence in elderly patients with gastrointestinal tumors to guide perioperative medication use and promote early patient recovery.

Methods: This study recruited 238 elderly patients (65 ≤ age ≤ 85) who underwent gastrointestinal tumor surgery; 117 cases were enrolled, and 55 controls of the same age and education level as the cases were included. Blood samples were taken preoperatively and at 7, 15, 30, and 90 days postoperatively, and plasma vitamin D (25OH-D3) and glutathione (GSH) was measured. Different from the previous diagnosis of POCD was obtained by telephone interview through Cognitive Status Modified Telephone Interview (TICS-m), mainly for memory impairment, a series of neuropsychological tests was used to evaluate cognitive function, Picture Recollect Test, Stroop Color-word Test, and Digit Symbol Substitution Test were used to comprehensively evaluate the three domains of cognitive function of patients, namely memory, attention and information processing ability. All neuropsychiatric assessments were performed at the bedside and completed face-to-face by the assessment staff and the patient.

Results: A total of 65.8% (77/117) of elderly patients undergoing gastrointestinal tumor surgery had preoperative vitamin D deficiency (serum 25OH-D concentration < 12 ng/ml), of whom 46.7% (36/77, 7 days after surgery), 31.2% (24/77, 15 days after surgery), 15.6% (12/77, 30 days after surgery), and 9% (7/77, 90 days after surgery) of patients developed POCD; 7.5% (3/40) of patients without vitamin D deficiency developed PNDs, which was detected only on the 7th day after surgery.

Conclusions: Vitamin D deficiency can increase neurocognitive disorder risk in elderly patients during the perioperative period, possibly because low vitamin D levels cannot effectively inhibit the postoperative oxidative stress increase.

Trial Registration: This experiment was approved and registered by the China Clinical Trial Registration Center, registration number ChiCTR2100046900 (30/05/2021).

3,403 views

14 citations

Original Research

12 April 2022

Potential Value of Serum Lipid in the Identication of Postoperative Delirium Undergoing Knee/Hip Arthroplasty: The Perioperative Neurocognitive Disorder and Biomarker Lifestyle Study

Yanan Lin

, 7 more and

Yanlin Bi

Objective: We aimed to investigate the relationship between preoperative lipid level and postoperative delirium (POD) and explore whether lipid’s effect on POD is mediated by POD core protein.

Methods: A total of 635 patients who were planned to undergo knee/hip arthroplasty under combined spinal-epidural anesthesia, regardless of gender, were selected. The patients were aged 40–90 years with American Society of Anesthesiologists physical status I II. The Mini-Mental State Examination (MMSE) was completed 1 day before the operation. Five milliliter elbow venous blood was taken from the patients before anesthesia, and serum levels of total cholesterol (TG), triglyceride (TC), low-density lipoprotein (LDL-C), and high-density lipoprotein (HDL-C) were detected. Cerebrospinal fluid (CSF) was extracted after successful spinal-epidural combined puncture, and amyloid beta₄₀ (Aβ₄₀), amyloid beta₄₂ (Aβ₄₂), total Tau (t-Tau), and phosphorylated Tau (p-Tau) in the CSF were measured by enzyme-linked immunosorbent assays (ELISA). After the operation, the occurrence and severity of POD were assessed using the Confusion Assessment Method and the Memorial Delirium Assessment Scale (MDAS), respectively. Patients were categorized into POD group and NPOD group. Logistic regression was used to analyze the relationship between POD and TC, TG, LDL-C, and HDL-C, and the mediating effect was used to analyze the role of POD core proteins in the relationship between lipid and MDAS. We used the receiver operating characteristic (ROC) and the precision-recall curve (PRC) analysis to assess the ability of TC, TG, LDL-C, and HDL-C ability to predict POD. Finally, we performed a sensitivity analysis to assess the stability of the results.

Results: A total of 562 patients were finally enrolled in this study, and 66 patients developed POD, with an incidence of 11.7%. Logistic regression analysis showed that high concentration of TC (OR = 3.148, 95%CI 1.858∼5.333, P < 0.001), TG (OR = 2.483, 95%CI 1.573∼3.918, P < 0.001), and LDL-C (OR = 2.469, 95%CI 1.310∼4.656, P = 0.005) in serum were risk factors for POD. A high concentration of HDL-C (OR = 0.258, 95%CI 0.112∼0.594, P = 0.001) was a protective factor for POD after adjusted for age, sex, education, and MMSE score. ROC curves showed that HDL-C have the highest sensitivity and specificity in predicting POD. For these four lipid markers, the PRC range from 0.602 to 0.731, respectively. The mediating analysis showed that POD core proteins could partially mediate the relationship between lipid and POD (effect value: 16.19∼91.04%). The results were barely changed in the sensitivity analysis, and the sensitivity analysis has shown that the results were stable.

Conclusion: The increase of serum TG, TC, and LDL-C concentration is a risk factor for POD development, while high HDL-C concentration is a protective factor for POD, and the occurrence of POD is caused by hyperlipidemia may be caused by POD core proteins.

Clinical Trial Registration: [www.ClinicalTrials.gov], identifier [Chictr200033439].

3,454 views

12 citations

Comparison of experimental results of spatial exploration. (A) Comparison of the times of crossing the platform: comparison with NC group: aP < 0.05; comparison with NS group: bP < 0.05. (B) Comparison of target quadrant activity time ratio: comparison between groups: *P < 0.05.

Original Research

10 June 2022

Effect of Different Vitamin D Levels on Cognitive Function in Aged Mice After Sevoflurane Anesthesia

Jialei Zhang

, 4 more and

Yonghao Yu

2,125 views

12 citations

Opinion

07 July 2022

Pre-operative Status of Gut Microbiota Predicts Post-operative Delirium in Patients With Gastric Cancer

Meiru Jiang

and

Wenfei Tan

1,655 views

1 citations

Changes in the gut microbiota between the POD group and non-POD group. The histogram of the LDA scores presented the relative abundance of the main bacterial in the two groups in the fecal samples. Blue boxes referred to the bacteria contributing a lot in the POD groups, yellow boxes referred to the bacteria contributing a lot in the non-POD group.

Original Research

04 April 2022

Mechanical Bowel Preparation Is a Risk Factor for Postoperative Delirium as It Alters the Gut Microbiota Composition: A Prospective Randomized Single-Center Study

Zhoujing Yang

, 3 more and

Yingwei Wang

Background and Objective: Postoperative delirium (POD) is a frequent complication in patients undergoing gastrectomy. Increasing evidence suggests that abnormal gut microbiota composition may contribute to its morbidity. However, it is unclear whether mechanical bowel preparation would cause postoperative delirium by altering the gut microbiota of patients. This study aimed to investigate the association between mechanical bowel preparation and postoperative delirium in patients undergoing gastrectomy.

Methods: A prospective randomized single-center study was performed. A total of 81 patients with gastric cancer were enrolled and randomly assigned to two groups: preparation group and non-preparation group according to whether the patient received MBP before surgery. To diagnose postoperative delirium, we used the 3-Min Diagnostic Interview for Confusion Assessment Method-defined delirium for five successive days after surgery. 16s rRNA gene sequencing was used to investigate changes in the intestinal bacteria. The linear discriminant analysis and effect size (LefSe) analysis were also used to identify the different taxa of fecal microbiota between the postoperative delirium and non-postoperative delirium groups.

Results: We found that there was a significant difference in β-diversity of the gut microbiota between the preparation group and non-preparation group (P = 0.048). Furthermore, patients in the preparation group had a much higher rate of postoperative delirium (13/40, 32.5%) compared with that in non-preparation groups (4/41, 9.8%). Multivariate regression analysis adjusted by other risk factors indicated that mechanical bowel preparation was associated with the occurrence of delirium (odds ratio = 4.792; 95% confidence interval: 1.274–18.028; P = 0.020). When comparing the gut microbiota of patients with and without POD, Bacteroides and Veillonella (genus), which were higher in the preparation group, were also higher in delirium patients (P < 0.05). Genus Olsenella was both relatively higher in the non-preparation group and non-POD group (P < 0.05).

Conclusion: Mechanical bowel preparation not only altered the gut microbiota composition of patients with gastric cancer but also increased the incidence of postoperative delirium. Among all the gut microbiota altered by mechanical bowel preparation, Bacteroides and Veillonella genus might be a risk factor of POD. Genus Olsenella might be a beneficial bacteria to reduce the incidence of POD.

3,327 views

15 citations

Original Research

03 March 2022

Preoperative Status of Gut Microbiota Predicts Postoperative Delirium in Patients With Gastric Cancer

Hu Liu

, 5 more and

Xue-sheng Liu

Introduction: Post-operative delirium (POD) is a serious complication which occurs after surgery, especially in the elderly undergoing abdominal surgery. Increasing evidence has revealed an association between the gut microbiota and psychological disorders involving the “brain-gut” axis. However, the association between the pathogenesis of POD after abdominal surgery in aging and composition of the gut microbiota remains unclear.

Methods: Forty patients (≥65 years old) who underwent abdominal surgery were included in the study. Twenty patients had POD, whereas 20 patients did not. POD was diagnosed and assessed using the confusion assessment method (CAM) during the postoperative period. Total DNA fractions were extracted from all fecal samples of patients. 16S rRNA sequencing was performed to determine the composition of the gut microbiota. The quality of the samples was determined by calculating the α- and β-diversities.

Results: The α- and β-diversities indicated that the samples were eligible for detection and comparison. We observed multiple differentially abundant bacteria in patients with and without POD. Generally, Proteobacteria, Enterbacteriaceae, Escherichia shigella, Klebsiella, Ruminococcus, Roseburia, Blautia, Holdemanella, Anaerostipes, Burkholderiaceae, Peptococcus, Lactobacillus, and Dorea were abundant in the POD cohort, whereas Streptococcus equinus and Blautia hominis were abundant in the control cohort. The results of receiver operating characteristic (ROC) curve analysis showed that the area under the curve (AUC) of Escherichia shigella was 0.75. Phenotype prediction showed that the gut microbiota may influence POD by altering the tolerance to oxidative stress.

Conclusion: There were significant associations between the pathogenesis of POD and composition of the gut microbiota. Escherichia shigella are promising diagnostic bacterial species for predicting POD onset after abdominal surgery in elderly people.

Clinical Trial Registration: http://www.chictr.org.cn/index.aspx, Chinese Clinical Trial Registry ChiCTR200030131.

5,178 views

19 citations

Correlation analysis for the time from injury to admission and the CAPS-5 score 1 month after surgery. (A) shows the propofol general anesthesia group (n = 142), and (B) shows the sevoflurane general anesthesia group (n = 139). Scatter plot (A) shows a significant negative correlation between the time from injury to admission and the CAPS-5 score 1 month after surgery (r = −0.226; p < 0.001), and (B) shows no significant correlation between the time from injury to admission and the CAPS-5 score 1 month after surgery (r = 0.002; p = 0.612).

Clinical Trial

25 February 2022

Effects of Sevoflurane and Propofol on Posttraumatic Stress Disorder After Emergency Trauma: A Double-Blind Randomized Controlled Trial

Junfeng Zhong

, 10 more and

Youjia Yu

Objective: Posttraumatic stress disorder (PTSD) is a frequent and disabling consequence of traumatic events. A previous study found that early use of propofol was a potential risk factor for PTSD. This prospective study aimed to investigate the effect of propofol and sevoflurane on PTSD after emergency surgery in trauma patients.

Methods: A total of 300 trauma patients undergoing emergency surgery were randomly divided into two groups and anesthetized with propofol and/or sevoflurane. Perioperative clinical data were collected. The incidence of PTSD was evaluated with the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) in the two groups 1 month after the operation. The relevance of the injury time and CAPS-5 scores was assessed by Spearman correlation analysis. Logistic regression analysis was used to analyze the risk factors for PTSD.

Results: The incidence of PTSD in the propofol group was higher than that in the sevoflurane group 1 month postoperatively (23.2 vs. 12.2%, P = 0.014). The injury time was negatively correlated with the CAPS-5 score in the propofol group (r = -0.226, P < 0.001). In the logistic regression analysis, the utilization of propofol was an independent risk factor for PTSD (P = 0.017).

Conclusion: Early use of propofol general anesthesia in emergency surgery for trauma patients may increase the risk of PTSD.

Clinical Trial Registration: www.chictr.org.cn, identifier: ChiCTR2100050202.

7,005 views

9 citations

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