A commentary on ‘Association between cerebrovascular disease and perioperative neurocognitive disorders: a retrospective cohort study’

Abstract

Dear Editor, Perioperative neurocognitive disorders (PNDs), covering a range of cognitive impairments linked to general anesthesia and surgery, pose a challenge in discerning the distinct contributions of anesthesia, surgery, or their combined effects despite their frequent occurrence following these interventions 1 . Individuals with cardiovascular disease (CVD) exhibit diminished resilience to surgical procedures and anesthesia, heightening vulnerability to perioperative cerebral ischemia and hypoxia, leading to subsequent repercussions on cognitive function 2 . Insufficient control and supervision of preoperative CVD may result in severe and life-threatening outcomes, affecting patient recuperation and prognosis. Hence, it is imperative not to disregard or marginalize the impact of preoperative CVD on postoperative results in individuals. The exploration of whether preoperative CVD heightens the risk of postoperative cognitive impairment carries considerable significance. We express our sincere appreciation to Feng et al. 3 for their insightful and valuable contribution showcased in the International Journal of Surgery, which conducted a retrospective cohort study involving 13 899 surgical patients through the electronic medical record system. Their comprehensive research delves into the intricate association between preoperative CVD and PNDs, representing a commendable effort in advancing our comprehension of these pivotal medical phenomena. We present valuable suggestions with the expectation of enhancing the quality of this article. Initially, in relation to the exclusion criteria, although the authors have set strict parameters for both participant inclusion and exclusion, we propose the addition of the following criteria: ‘1. Presence of a significant mental disorder’ and ‘2. History of substantial alcohol misuse.’ These considerations are crucial as they may elevate the risk of cognitive impairment, subsequently influencing the assessment of cognitive levels post-surgery. Secondly, the study meticulously adjusted for various crucial covariates to mitigate the potential influence of confounding factors on outcomes. This encompassed age, gender, hypertension, diabetes, hyperlipidemia, coronary heart disease, intraoperative blood pressure, and antibiotics. Despite the authors adjusting for some covariates as rigorously and comprehensively as possible, we recommend enhancing consideration for additional potential confounders. This includes income, education, marital status, smoking, alcohol consumption, dietary habits, physical activity, body mass index, sleep duration, total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), C-reactive protein, anticoagulant medication, and psychotropic medication. This would further fortify the reliability and stability of the study’s results 4 . Lastly, to assess the robustness of associations between CVD and PNDs across various demographics and pinpoint potential population-specific determinants, we recommend conducting subgroup analyses and interaction tests. This should take into account diverse demographic and health-related factors, including gender, age, race, body mass index, diabetes, hyperlipidemia, and smoking status 5 . This approach will enhance our comprehension of variations in environmental impacts among distinct populations. In summary, Feng et al.’s study significantly advances our understanding by offering a comprehensive perspective on the correlation between CVD and PNDs. This study contributes novel and profound insights into assessing the prognosis of postoperative cognitive impairment, establishing a robust foundation for formulating therapeutic strategies aimed at ameliorating postoperative cognitive decline. We appreciate the opportunity to provide feedback on this study and look forward to the ongoing contributions of Feng et al. in PNDs research, anticipating that our recommendations contribute to its continuous academic excellence. Ethical approval Not applicable. Sources of funding This work was supported by 2022QNJJ04(Kunshan Traditional Chinese Medicine Hospital Youth Science and Technology Fund). Author contribution All authors read and approved the final version of the manuscript. Conflicts of interest disclosure The authors declare no conflicts of interest. Research registration unique identifying number (UIN) Name of the registry: not applicable. Unique identifying number or registration ID: not applicable. Hyperlink to your specific registration (must be publicly accessible and will be checked): not applicable. Guarantor Bo Wei. Data availability statement The data underlying this article will be shared by the corresponding author upon reasonable request. No data were generated during the writing of this study.