Risk Factors for Postoperative Cognitive Dysfunction Following Multilevel Lumbar Spinal Fusion

作者：Mladen Djurasovic, Steven D. Glassman, Justin Mathew, Jeffrey L. Gum, Desiree Chappell, Christy L. Daniels, Colleen Mahoney, Morgan Brown, Benjamin Kostic, Leah Y. Carreon · 发表于：Spine · 年份：2025 · DOI：10.1097/brs.0000000000005420 · 被引用次数：3 · 研究领域：Intensive Care Unit Cognitive Disorders、Intracranial Aneurysms: Treatment and Complications、Enhanced Recovery After Surgery

STUDY DESIGN: Retrospective observational cohort. OBJECTIVES: To determine the incidence of and risk factors for postoperative cognitive dysfunction (POCD) following multilevel spine fusion. SUMMARY OF BACKGROUND DATA: POCD is a serious, common and under-recognized complication in elderly patients undergoing surgery. Risk factors for POCD vary in the literature and include preoperative as well as intraoperative factors. MATERIALS AND METHODS: A retrospective cohort of 566 thoracolumbar fusion cases with a minimum of 4 surgical levels were identified. A chart review was performed for the occurrence of POCD and known risk factors for POCD. Anesthetic and surgical data included operative time, fluid volume, blood loss, blood product replacement, and use of vasopressors. Arterial line-based mean arterial pressure (MAP) data were collected at 1-minute intervals, and the cumulative duration of MAP <65 mm Hg was recorded. Univariate and multivariate statistical analysis was used to investigate the relationship between demographic, preoperative and intraoperative risk factors, and the occurrence of POCD. RESULTS: Overall, 70 out of 566 patients (12.4%) experienced POCD described most commonly as encephalopathy (57, 81%), delirium (8, 11%), hallucinations (3, 4%), and altered mental status (2, 3%). Patients who developed POCD were older (68.7 yr vs . 59.6 yr, P <0.001), had a worse ASA scores (2.9 vs . 2.7, P =0.004), higher BMI (32.0 vs . 30.0, P =0.007), a higher incidence of diabet...