Intraoperative impaired cerebrovascular autoregulation and delayed neurocognitive recovery after major oncologic surgery - a secondary analysis of pooled data
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Intraoperative impaired cerebrovascular autoregulation and delayed neurocognitive recovery after major oncologic surgery - a secondary analysis of pooled data. / Kahl, Ursula; Rademacher, Cornelius; Harler, Ulrich; Juilfs, Neelke; Pinnschmidt, Hans O; Beck, Stefanie; Dohrmann, Thorsten; Zöllner, Christian; Fischer, Marlene.
In: J CLIN MONIT COMPUT, Vol. 36, No. 3, 06.2022, p. 765-773.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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T1 - Intraoperative impaired cerebrovascular autoregulation and delayed neurocognitive recovery after major oncologic surgery - a secondary analysis of pooled data
AU - Kahl, Ursula
AU - Rademacher, Cornelius
AU - Harler, Ulrich
AU - Juilfs, Neelke
AU - Pinnschmidt, Hans O
AU - Beck, Stefanie
AU - Dohrmann, Thorsten
AU - Zöllner, Christian
AU - Fischer, Marlene
PY - 2022/6
Y1 - 2022/6
N2 - Cerebral blood flow is tightly regulated by cerebrovascular autoregulation (CVA), and intraoperative impairment of CVA has been linked with perioperative neurocognitive disorders. We aim to assess whether impairment of CVA during major oncologic surgery is associated with delayed neurocognitive recovery (DNCR) postoperatively. We performed a secondary analysis of prospectively collected data. Patients were included if they had undergone complete pre- and postoperative neuropsychological assessments, continuous intraoperative measurement of CVA, and major oncologic surgery for visceral, urological, or gynecological cancer. Intraoperative CVA was measured using the time-correlation method based on near-infrared-spectroscopy, and DNCR was assessed with a neuropsychological test battery. A decline in cognitive function before hospital discharge compared with a preoperative baseline assessment was defined as DNCR. One hundred ninety-five patients were included in the analysis. The median age of the study population was 65 years (IQR: 60-68); 11 patients (5.6%) were female. Forty-one patients (21.0%) fulfilled the criteria for DNCR in the early postoperative period. We found a significant association between impaired intraoperative CVA and DNCR before hospital discharge (OR = 1.042 [95% CI: 1.005; 1.080], p = 0.028). The type of surgery (radical prostatectomy vs. other major oncologic surgery; OR = 0.269 [95% CI: 0.099; 0.728], p = 0.010) and premedication with midazolam (OR = 3.360 [95% CI: 1.039; 10.870], p = 0.043) were significantly associated with the occurrence of DNCR in the early postoperative period. Intraoperative impairment of CVA is associated with postoperative neurocognitive function early after oncologic surgery. Therefore, intraoperative monitoring of CVA may be a target for neuroprotective interventions. The initial studies were retrospectively registered with primary clinical trial registries recognized by the World Health Organization (ClinicalTrials.gov Identifiers: DRKS00010014, 21.03.2016 and NCT04101006, 24.07.2019).
AB - Cerebral blood flow is tightly regulated by cerebrovascular autoregulation (CVA), and intraoperative impairment of CVA has been linked with perioperative neurocognitive disorders. We aim to assess whether impairment of CVA during major oncologic surgery is associated with delayed neurocognitive recovery (DNCR) postoperatively. We performed a secondary analysis of prospectively collected data. Patients were included if they had undergone complete pre- and postoperative neuropsychological assessments, continuous intraoperative measurement of CVA, and major oncologic surgery for visceral, urological, or gynecological cancer. Intraoperative CVA was measured using the time-correlation method based on near-infrared-spectroscopy, and DNCR was assessed with a neuropsychological test battery. A decline in cognitive function before hospital discharge compared with a preoperative baseline assessment was defined as DNCR. One hundred ninety-five patients were included in the analysis. The median age of the study population was 65 years (IQR: 60-68); 11 patients (5.6%) were female. Forty-one patients (21.0%) fulfilled the criteria for DNCR in the early postoperative period. We found a significant association between impaired intraoperative CVA and DNCR before hospital discharge (OR = 1.042 [95% CI: 1.005; 1.080], p = 0.028). The type of surgery (radical prostatectomy vs. other major oncologic surgery; OR = 0.269 [95% CI: 0.099; 0.728], p = 0.010) and premedication with midazolam (OR = 3.360 [95% CI: 1.039; 10.870], p = 0.043) were significantly associated with the occurrence of DNCR in the early postoperative period. Intraoperative impairment of CVA is associated with postoperative neurocognitive function early after oncologic surgery. Therefore, intraoperative monitoring of CVA may be a target for neuroprotective interventions. The initial studies were retrospectively registered with primary clinical trial registries recognized by the World Health Organization (ClinicalTrials.gov Identifiers: DRKS00010014, 21.03.2016 and NCT04101006, 24.07.2019).
U2 - 10.1007/s10877-021-00706-z
DO - 10.1007/s10877-021-00706-z
M3 - SCORING: Journal article
C2 - 33860406
VL - 36
SP - 765
EP - 773
JO - J CLIN MONIT COMPUT
JF - J CLIN MONIT COMPUT
SN - 1387-1307
IS - 3
ER -