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Archives of Orthopaedic and Trauma Surgery

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27-10-2023 | Orthopaedic Surgery

Postoperative cognitive dysfunction after beach chair positioning compared to supine position in orthopaedic surgery in the elderly

Authors: Philipp Groene, Tanja Schaller, Catharina Zeuzem-Lampert, Margret Rudy, Ben Ockert, Georg Siebenbürger, Thomas Saller, Peter Conzen, Klaus Hofmann-Kiefer

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 2/2024

Abstract

Introduction

Postoperative cognitive dysfunction (POCD) occurs in up to 26% of patients older than 60 years 1 week after non-cardiac surgery. Intraoperative beach chair positioning (BCP) is advantageous for some types of shoulder surgery. However, this kind of positioning leads to a downward bound redistribution of blood volume, with possible hypoperfusion of the brain. We hypothesized that patients > 60 years undergoing orthopaedic shoulder surgery in a BCP might experience more POCD than patients operated in the supine position (SP).

Material and methods

A single-centre, prospective observational trial of 114 orthopaedic patients was performed. Study groups were established according to the type of intraoperative positioning. Anaesthesiological management was carried out similarly in both groups, including types of anaesthetics and blood pressure levels. POCD was evaluated using the Trail Making Test, the Letter–Number Span and the Regensburger Word Fluency Test. The frequency of POCD 1 week after surgery was considered primary outcome.

Results

Baseline characteristics, including duration of surgery, were comparable in both groups. POCD after 1 week occurred in 10.5% of SP patients and in 21.1% of BCP patients (p = 0.123; hazard ratio 2.0 (CI 95% 0.794–5.038)). After 4 weeks, the incidence of POCD decreased (SP: 8.8% vs. BCP: 5.3%; p = 0.463). 12/18 patients with POCD showed changes in their Word Fluency Tests. Near-infrared spectroscopy (NIRS) values were not lower in patients with POCD compared to those without POCD (54% (50/61) vs. 57% (51/61); p = 0.671).

Conclusion

POCD at 1 week after surgery tended to occur more often in patients operated in beach chair position compared to patients in supine position without being statistically significant.

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Title: Postoperative cognitive dysfunction after beach chair positioning compared to supine position in orthopaedic surgery in the elderly
Authors: Philipp Groene
Tanja Schaller
Catharina Zeuzem-Lampert
Margret Rudy
Ben Ockert
Georg Siebenbürger
Thomas Saller
Peter Conzen
Klaus Hofmann-Kiefer
Publication date: 27-10-2023
Publisher: Springer Berlin Heidelberg
Published in: Archives of Orthopaedic and Trauma Surgery / Issue 2/2024
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-023-05109-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Postoperative cognitive dysfunction after beach chair positioning compared to supine position in orthopaedic surgery in the elderly

Abstract

Introduction

Material and methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Material and methods

Results

Conclusion

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