Predictive value of ASA classification and comorbidity assessment for postoperative cognitive dysfunction after total hip arthroplasty in elderly patients
ZHANG Shuguo
HAN Lixin
Abstract：Objective To explore the predictive value of the American Society of Anesthesiologists(ASA)classification and comorbidity assessment for postoperative cognitive dysfunction(POCD)after total hip arthroplasty(THA)in elderly patients,and to provide a basis for formulating individualized preventive strategies.Methods A total of 98 elderly patients who underwent THA in Zhengzhou 15th People's Hospital from January 2018 to December 2023 were prospectively enrolled.Preoperative ASA classification and modified Charlson comorbidity index(mCCI)were evaluated,and neuropsychological scale combinations were used to assess cognitive function before surgery,and 7 days and 30 days after surgery.Logistic regression was used to analyze the risk factors of POCD,and a prediction model was constructed and its efficacy was verified.Results The incidence of POCD at 7 days after surgery was 21.43％,mainly involving the executive function(76.19％)and attention and working memory domains(71.43％).Multivariate Logistic regression analysis showed that age≥73.6 years(OR=2.373),educational duration≤8.5 years(OR=2.113),ASA grade Ⅲ(OR=2.824),and mCCI score≥2.8 points(OR=2.237)were independent risk factors for POCD.The prediction model showed good discrimination(AUC=0.839,95％CI:0.762-0.916,P<0.001),with a sensitivity of 82.4％and a specificity of 78.6％.Conclusions The combination of ASA classification and comorbidity assessment can effectively predict the cognitive risk after THA,providing a standardized assessment tool for perioperative management by orthopedic surgeons.It helps identify high-risk patients and formulate targeted preventive measures,which is of great clinical value for improving the safety of THA in elderly patients.
Keywords：ArthroplastyreplacementhipPostoperative complicationsCognitive dysfunctionASA classificationRisk factorsPredictive model
Publication Date：2025-04-15
Online Publishing Date：2025-09-22(First online date of this platform, not the publication date of the document)
Pages：7( 110-116 )