Incidence and Predictors of Postoperative Cognitive Dysfunction among Elderly Elective Surgical Patients at Selected Governmental Hospitals in Southern Ethiopia, 2023 GC: A Multicenter Prospective Single Arm Cohort Study

Introduction: Geriatrics population is the fast-growing age group which accounts for one-third of surgical patients. Body of evidence revealed that postoperative cognitive dysfunction is the commonest complication among older surgical patients. However, there is a huge disparity in the incidence, and independent predictors globally. Besides, evidences are lacking in sub-Saharan Africa as well as in Ethiopia. Objective To assess the incidence and predictors of postoperative cognitive dysfunction among geriatric patients undergoing elective surgery in selected southern governmental hospitals, from February 2023 to October 2023 GC. Method A multi-center single arm prospective cohort study conducted in selected governmental hospitals on patients’ age ≥ 60 years old. Binary logistic regression was used to assess the relationship between dependent and independent variables and p value < 0.05 was used to determine the significance and crude and adjusted odds ratio with 95%CI was calculated to determine the strength of association of the variable. The mean difference between preoperative cognitive status postoperative cognitive statuses at each follow up postoperative day analyzed by repeated measure ANOVA. Result The overall incidence of postoperative cognitive dysfunction was 46.5%, and the trend in incidence displayed a gradual decrease in the mean Montreal Cognitive Assessment score from the 3rd postoperative day to the 30th day [0 day (preoperative) 25.94 ± 2.884, 3rd day 24.18 ± 3.9, 7th day 24.84 ± 3.62, and 30th day 25.23 ± 3.561)] P < 0.0001, large effect size (Partial Eta Squared (ηp2) – 0.98). Age, ASA III classification, female gender, major surgeries, frailty, preoperative depression, type of anesthesia, intraoperative hypotension and blood loss, duration of surgery and anesthesia were significantly associated with POCD with p value < 0.05. Conclusion and recommendation: The study found a substantial incidence of postoperative cognitive dysfunction in geriatric patients following elective surgery. The results of this study demonstrate the scope and complexity of POCD as well as the range of important variables that associated with cognitive dysfunction. It's important for healthcare providers to consider cognitive assessments as part of a holistic approach to patient care, especially for those with risk factors for POCD.