POCD After Major Gynecologic Surgery

This prospective observational cohort study aims to investigate the incidence of early postoperative cognitive dysfunction (POCD) and associated perioperative risk factors in adult patients undergoing major gynecological surgery under general anesthesia. Eligible patients undergoing total abdominal hysterectomy and/or bilateral salpingo-oophorectomy through open or laparoscopic approaches will be included. Cognitive function will be evaluated using the Turkish version of the Montreal Cognitive Assessment (MoCA) before surgery and again on postoperative day 3 (±1 day). POCD will be defined as either a relative decline of ≥20% from baseline MoCA score or an absolute decrease of ≥2 points. Demographic characteristics, frailty status, menopausal status, hematologic-inflammatory markers including hemoglobin, RDW, and neutrophil-to-lymphocyte ratio, as well as intraoperative hemodynamic and surgical variables, will be recorded. The associations between these perioperative factors and POCD development will be analyzed. The findings may help identify high-risk patients preoperatively and contribute to individualized perioperative neuroprotective strategies.

Primary outcomes

• Early Postoperative Cognitive Dysfunction [Preoperative baseline assessment within 0-14 days before surgery and postoperative day 3 (±1 day)]: Postoperative cognitive dysfunction assessed using the Montreal Cognitive Assessment (MoCA; score range 0 to 30, with higher scores indicating better cognitive function). POCD will be defined as either a ≥20% relative decline or a ≥2-point decrease from the preoperative baseline MoCA score.

Secondary outcomes

• Change in MoCA Score [T0: preoperative baseline assessment within 0-14 days before surgery, T1: postoperative day 3 (±1 day)]: Absolute change (points) and relative change (%) in Montreal Cognitive Assessment (MoCA; score range 0 to 30, with higher scores indicating better cognitive function) scores at postoperative day 3 (T1) compared with preoperative baseline (T0).
• Correlation Between Preoperative Frailty Status and Postoperative Cognitive Dysfunction [Preoperative frailty assessment within 0-14 days before surgery; postoperative cognitive assessment on postoperative day 3 (±1 day).]: Correlation between preoperative frailty status assessed by the Clinical Frailty Scale (CFS-TR v2; score range 1 to 9, with higher scores indicating greater frailty) and change in Montreal Cognitive Assessment (MoCA) score (points and %) from baseline to postoperative day 3.

Sex: Female, ages: 18 Years to any

Inclusion Criteria:

* Female patients aged ≥18 years
* Scheduled for elective major gynecological surgery under general anesthesia
* Total abdominal hysterectomy and/or bilateral salpingo-oophorectomy
* Open or laparoscopic surgical approach
* Ability to complete the Turkish version of the Montreal Cognitive Assessment (MoCA)
* Ability to understand and provide written informed consen

Exclusion Criteria:

* Pre-existing dementia or major neurocognitive disorder
* History of cerebrovascular event within the previous 3 months
* Severe visual or hearing impairment preventing cognitive assessment
* Emergency or hemodynamically unstable surgery
* Planned postoperative sedation or mechanical ventilation longer than 72 hours
* Postoperative delirium detected during assessment
* Inability to communicate or cooperate
* Refusal to participate

• Ren S, Yuan F, Yuan S, Zang C, Zhang Y, Lang B. Early Cognitive Dysfunction in Elderly Patients after Total Knee Arthroplasty: An Analysis of Risk Factors and Cognitive Functional Levels. Biomed Res Int. 2022 Feb 18;2022:5372603. doi: 10.1155/2022/5372603. eCollection 2022. PMID 35224095