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.