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

  • Orthopaedic Surgery
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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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Data availability

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

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Acknowledgements

The authors thank PD Dr. Karch for helping us select psychometric testing methods and we would like to thank all staff of the operating theatre and the wards who supported the team.

Funding

This study was funded in part by an internal grant from the Ludwig-Maximilians-University to Philipp Groene. Förderung Forschung und Lehre (FöFoLe).

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Authors and Affiliations

  1. Department of Anaesthesiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany

    Philipp Groene, Tanja Schaller, Catharina Zeuzem-Lampert, Margret Rudy, Thomas Saller, Peter Conzen & Klaus Hofmann-Kiefer

  2. Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Munich, Germany

    Ben Ockert & Georg Siebenbürger

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  1. Philipp Groene
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Correspondence to Philipp Groene.

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The authors have no competing interests to declare that are relevant to the content of this article.

Ethical approval

This study was registered at the German clinical trials database (ID: DRKS00015271), and the study protocol was approved by the Ludwig-Maximilians-University’s ethics committee (No 18-558). This study was performed in accordance with the Declaration of Helsinki, with written informed consent being obtained from all participants before they undertook any of the study procedures.

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Groene, P., Schaller, T., Zeuzem-Lampert, C. et al. Postoperative cognitive dysfunction after beach chair positioning compared to supine position in orthopaedic surgery in the elderly. Arch Orthop Trauma Surg 144, 575–581 (2024). https://doi.org/10.1007/s00402-023-05109-0

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