Post Operation Cognitive Dysfunction

Some provocative thoughts about patient concern about POCD. 
POCD is a topic of active research.  Subtle but real changes in cognitive function follow surgery.  But on some studies it is even more frequent after surgery under spinal of local anaesthesia.  And (in some studies) the same changes happen in non-surgical patients being hospitalised.  Whatever the phenomenon represents, it is not a ‘simple’ effect of exposure to propofol or a volatile anaesthetic.
POCD is also a topic of great community concern.  It can easily be portrayed as a big problem (e.g. “up to” 30%) which is terrifying if you (the patient) think you are going to suddenly be drooling and vegetative.  That is not the case.  The reality is it is mostly very subtle changes that can only be picked up by very sensitive testing.  And it is an area of active research/controversy.
It helps to portray it as a BIG problem if you are in the field of research, and wanting funding for your project.  But this may be causing inappropriate concern in the community.  The ‘conventional’ risks of  surgery/procedures are still of much more relevance.
Part of the problem as well is the effect of suggestion – are you forgetting someone’s name
because you forget them or is this the onset of dementia (or is it the effect of the
anaesthetic?….).   This is fertile ground for anxiety and the anxious patient.   It is a bit like HIV and blood transfusions, or terrorism, or  african killer bees – yes it exists, (or in this case at this stage appears to) but it can be overemphasised.
You have to make choices about how you spend your life.   Overall, it is wise not to have
surgery and anaesthetic unless you need it. (This seems obvious, but may possibly be relevant for choosing between spinals and GAs for some surgery, although this may not make much difference to POCD anyway…).

You should decide whether or not to go ahead after considering all the risks, and the benefits. Don’t underestimate the ‘conventional’ risks and don’t overemphasise the rare or minor risks. And think carefully about whether there really is any benefit in the proposed procedure….

 

Background/Reference Material

Discussion Notes

 

 

To make comments or suggest any changes to this guideline please send your email to perioptalkdesk@gmail.com