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Cognitive Changes After Surgery in the Elderly: Does Minimally Invasive Surgery Influence the Incidence of Postoperative Cognitive Changes Compared to Open Colon Surgery?
Christopher B. Tan*1,2, Dhyan Rajan1, Mitanshu Shah1, Vikas Garg1, Jackson NG3, Fernando Kawai2, Cynthia PAN2, James Turner3, Steven Cohen3, Mitchell Chorost3, Paul Mustacchia1
1Gastroenterology, Nassau University Medical Center, East Meadow, NY; 2Geriatrics, New York Hospital Medical Center Queens, Flushings, NY; 3Surgery, New York Hospital Medical Center Queens, East Meadow, NY
Background: Post-operative delirium (POD) in the elderly is a growing concern. Data regarding significant differences in postoperative cognitive dysfunction (POCD) in elderly undergoing laparoscopic versus open colon resection is not well established.
Objectives: The goal of this study was to compare the incidence of POCD in laparoscopic versus open colon surgery in an elderly population.
Design & Setting: A prospective, non-randomized pilot study was conducted at an urban tertiary care hospital.
Participants: Patients aged 65 and above, without documented dementia, undergoing elective colon surgery.
Measurements: We collected demographic and clinical data, including age, sex, polypharmacy, and comorbidities. Subjects underwent pre- and post-op CANTAB (Cambridge Neuropsychological Test Automated Battery) testing. Worsening individual scores from Paired Associated Learning (PAL) and Spatial Working Memory (SWM) portions of CANTAB determined the presence of POCD. Inflammatory cytokines (i.e., IL-6) levels were measured pre and post-operatively.
Results: We enrolled 44 subjects (26 laparoscopic and 18 open surgery). The two groups did not differ significantly in age, sex, polypharmacy, and comorbidities. Average incidence of POCD was 47%. PAL scores worsened in 12/23 (52%) in the laparoscopic group and 7/15 (47%) in the open group. These group differences lacked statistically significance (P = 0.75). SWM scores worsened in 14/25 (56%) in the laparoscopic group and 6/18 (33%) in the open group; also not statistically significant (P = 0.12). No age difference occurred between the "worsened scores" group and "stable scores" group; older age was not associated with POCD. IL-6 levels were higher in the open vs. laparoscopic group (P <.0001).
Conclusion:
In this pilot study, the average incidence of POCD was not statistically different between elderly subjects undergoing open vs. laparascopic surgery. Age did not influence the occurrence of POCD. Although inflammatory markers were significantly higher in the open group, consistent with a higher degree of stress response, the open group did not have higher rates of delirium. This association is worth investigating in a larger sample size.
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