TỶ LỆ RỐI LOẠN NHẬN THỨC Ở NGƯỜI CAO TUỔI SAU GÂY TÊ TỦY SỐNG TRONG PHẪU THUẬT THAY KHỚP HÁNG VÀ KHỚP GỐI

Abstract

Background: Postoperative cognitive dysfunction in the elderly greatly affects the quality of recovery after surgery, increases infectious complications, increases respiratory complications, prolongs hospital stay, and reduces quality of life, increasing medical care costs. Objective: Determine the rate  of postoperative cognitive dysfunction in the elderly after spinal anesthesia for hip and knee joint arthroplasty in postoperative 5 days. Materials and Methods: Elderly patients (≥ 60 years) receiving spinal anesthesia for joint arthroplasty. Patient cognition was assessed using Mini – Mental State Examination 1 day before surgery and in postoperative 5 days. This single-center, longitudinal observational, prospective study and analytical research methods based on survival analysis with the appearance of cognitive dysfunction in postoperative 5 days. Results: 22,5% of elderly patients had postoperative cognitive dysfunction for joint arthroplasty and received spinal anesthesia in the first 5 days of surgery. Multivariable Cox regression analysis had 3 risk factors: use of sedative midazolam during surgery (p = 0,002); perioperative blood transfusion of more than 2 units of red blood cells (p = 0,01) and moderate pain level on day 1 (p = 0,008). Conclusions: Of all the 107 patients, 24 (22,5%) developed postoperative cognitive dysfunction in postoperative 5 days, occurring on medium 2 days after surgery. There are 3 risk factors for postoperative cognitive dysfunction: the use of sedative midazolam during surgery, perioperative blood transfusion of more than 2 units of red blood cells and moderate pain level on day 1.