COMPLICATION

The anesthesiologist’s goal is to make the patient in a cognitive and physical state identical to his preoperative state. Due to surgical progress and under the effect of the aging of the population, the neurological fate of operated patients represents a growing challenge for the clinician.

On the one hand, the risk of delirium and postoperative cognitive decline is doubled every ten years from the age of 60, on the other hand the category of operated patients over 80 years old is the one that increases the faster. The factors predisposing to cognitive decline are now relatively well known, and it has been shown in particular that a subject over 65 years of age, presenting a preoperative state of fragility, an altered vascular state, diabetes, dyslipidemia, chronic renal failure or history of transient or constituted vascular accidents are all elements that raise concerns about intraoperative brain damage. To this is added the extent of the surgical procedure, its duration, the wide variations in load conditions linked to blood loss during the procedure, which can exceed the capacities of cerebral self-regulation, be the cause of irreversible damage. Neurological complications are thus the first complication of patients over 65 in a number of surgeries.

The occurrence of deliriums and cognitive decline directly impact the potential for postoperative rehabilitation, hospital mortality and superior function of patients in the long term[i].They reduce the quality of life and accelerate the loss of autonomy of the patients concerned [ii][iii][iv].

In order to optimize the neurological management of the most vulnerable patients, the clinician requires a brain monitoring solution allowing an individualization of the anesthetic management of fragile patients.

 

KEY FIGURES

N°1

postoperative complication over 65 of age

+50K€

average cost (hospitalization, institutionalization, long-term care …)

 

x2

Hospital mortality

+7 days

average length of stay

[i] Maria Lundström RN 2003. Dementia after Delirium in Patients with Femoral Neck Fractures. Journal of the american geriatric society
[ii] Jane S. Saczynski, Ph.D., Edward R. Marcantonio, M.D. Cognitive Trajectories after Postoperative Delirium. New England Journal of Medecine, 2012<
[iii]Jacob Steinmetz et al. Long-term consequences of postoperative cognitive  dysfunction. Anesthesiology 2009; 110:548 –55
[iv] Levkoff, Arch. Int Med 1992 ; Innouye, J Gen int Med 1998