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

Abstract Introduction The geriatric population is the fastest-growing age group and accounts for one-third of surgical patients. A growing body of evidence reveals that postoperative cognitive dysfunction (POCD) is the most common complication among older surgical patients. However, there is a wide variation in incidence and independent predictors globally. Furthermore, there is a lack of evidence in sub-Saharan Africa, including Ethiopia. Objective To assess the incidence and predictors of postoperative cognitive dysfunction among geriatric patients undergoing elective surgery in selected governmental hospitals in southern Ethiopia, from February 2023 to October 2023 G.C. Method A multi-center, single-arm prospective cohort study was conducted in selected governmental hospitals on patients aged ≥ 60 years. Binary logistic regression was used to assess the relationship between dependent and independent variables, with a p-value < 0.05 considered statistically significant. Crude and adjusted odds ratios with 95% confidence intervals (CI) were calculated to determine the strength of association. The mean differences between preoperative and postoperative cognitive statuses at each follow-up day were analyzed using repeated measures ANOVA. Results The overall incidence of postoperative cognitive dysfunction was 46.5%. The trend in incidence showed a gradual decrease in the mean Montreal Cognitive Assessment (MoCA) score from the 3rd postoperative day to the 30th day [Preoperative: 25.94 ± 2.884; 3rd day: 24.18 ± 3.9; 7th day: 24.84 ± 3.62; 30th day: 25.23 ± 3.561; p < 0.0001; large effect size (Partial Eta Squared (ηp²) = 0.98)]. Factors significantly associated with POCD (p < 0.05) included age, ASA III classification, female gender, major surgeries, frailty, preoperative depression, type of anesthesia, intraoperative hypotension and blood loss, and duration of surgery and anesthesia. Conclusion and recommendation This study found a substantial incidence of postoperative cognitive dysfunction in geriatric patients undergoing elective surgery. The findings highlight the complexity of POCD and the wide range of contributing factors. Healthcare providers should include cognitive assessments as part of a holistic approach to patient care, particularly for those at risk of POCD.