DISCUSSION
The present prospective observational study of 70 patients aged ≥ 65 years undergoing elective inguinal hernia repair demonstrated a significant burden of early POCD. To our knowledge, the literature on POCD is generally concentrated on cardiovascular and orthopedic surgery, and there are only a few articles on minor surgeries, which constitute the majority of cases5,6,10,11. In a sample of 30 patients who underwent cystoscopy or hysteroscopy, Rohan et al. reported that POCD was present in 47% of patients who received propofol and 47% of patients who received sevoflurane11. In our observational study involving 70 patients, the incidence of early POCD was similar between the general and spinal anesthesia groups (31.9% and 34.7%, respectively, with p = 0.810), with an overall incidence of 32.9%.
Current evidence in the literature shows that there is no long-term cognitive impairment attributable to surgery and anesthesia18,19 . However, considering that, in the early postoperative period, POCD may adversely affect quality of life and patient outcomes, it can be assumed that cognitive screening via neuropsychiatric tests is important both for elderly patients’ outcomes and hospital costs9 .
Although many neuropsychiatric tests with different advantages have been previously used for cognitive screening, it is unclear which of them is more effective in screening for POCD. In agreement with the current literature15-17, our study showed that the MoCA test could detect cognitive decline in both the general and spinal anesthesia groups, while the MMSE test only in the general anesthesia group.
When we examined the demographic characteristics of the patients with and without POCD, the anesthesia method used, duration of operation, and laboratory results, we could not find any differences between the groups. Similar results have been obtained in the literature, where no variation was observed for different intraoperative anesthesia techniques in patients with POCD 20. The reason for not being able to determine the factors causing POCD may be due to the limitations of our study, enumerated as follows.
First, the influence of characteristics such as anxiety and sociocultural levels, which may have affected the cognitive functions of the patients, was not investigated, as we focused on medical features such as laboratory results, comorbidities, and the anesthesia method used. However, preoperative anxiety and low educational attainment have been reported to be associated with an increased risk of decline in executive function21 . Second, the pain levels of the patients were not determined. Postoperative pain is a modifiable factor that has been shown to be associated with delirium and cognitive decline20.