Editorial Views  |   February 2016
The Fallacy of Persistent Postoperative Cognitive Decline
Author Notes
  • From the Department of Anesthesiology, Washington University School of Medicine, St. Louis, Missouri.
  • This article has been selected for the Anesthesiology CME Program. Learning objectives and disclosure and ordering information can be found in the CME section at the front of this issue.
    This article has been selected for the Anesthesiology CME Program. Learning objectives and disclosure and ordering information can be found in the CME section at the front of this issue.×
  • Corresponding article on page 312.
    Corresponding article on page 312.×
  • Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org).
    Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org).×
  • Accepted for publication August 21, 2015.
    Accepted for publication August 21, 2015.×
  • Address correspondence to Dr. Avidan: avidanm@anest.wustl.edu
Article Information
Editorial Views / Central and Peripheral Nervous Systems / Geriatric Anesthesia
Editorial Views   |   February 2016
The Fallacy of Persistent Postoperative Cognitive Decline
Anesthesiology 2 2016, Vol.124, 255-258. doi:10.1097/ALN.0000000000000958
Anesthesiology 2 2016, Vol.124, 255-258. doi:10.1097/ALN.0000000000000958
THERE is a widespread belief in the medical community and lay public that anesthesia and surgery pose a substantial risk of producing long-term cognitive damage in elderly patients. This view endures despite a growing body of clinical research data showing that major surgery and general anesthesia are unlikely to cause persistent postoperative cognitive decline (POCD) or incident dementia. Viewing the studies in an evidential pyramid illustrates that the weight of clinical evidence is heavily tilted against persistent POCD attributable to surgery or anesthesia in older surgical patients (fig. 1 and Supplemental Digital Content 1, online appendix, http://links.lww.com/ALN/B226). The study by Dokkedal et al.1  in this issue of Anesthesiology reinforces this perspective by using a powerful methodological approach. Dokkedal et al.1  examine the association between exposure to surgery and long-term cognition in a Danish cohort of 8,503 middle-aged and elderly twins. Their findings substantiate the current evidence of no clinically relevant persistent POCD attributable to surgery or anesthesia, whereas preoperative cognitive trajectory and coexisting disease burden are likely to be strongly predictive of long-term postoperative cognitive trajectory.1  The large number of patients and the use of rigorous longitudinal cognitive testing in this study increased the reliability of the findings and echoed the results of another twin study that followed World War II veteran twin pairs between 1990 and 2002 and found no negative cognitive effects on the twin who underwent heart surgery.2 
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