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Effectiveness of cognitive interventions for adult surgical patients after general anaesthesia to improve cognitive functioning: a systematic review

Bowden, T. ORCID: 0000-0003-2614-3707, Hurt, C. S. ORCID: 0000-0003-1571-0040, Sanders, J. & Aitken, L. M. ORCID: 0000-0001-5722-9090 (2022). Effectiveness of cognitive interventions for adult surgical patients after general anaesthesia to improve cognitive functioning: a systematic review. Journal of Clinical Nursing, doi: 10.1111/jocn.16423

Abstract

Aims and objectives
To examine the effectiveness of cognitive interventions after general anaesthesia to improve cognitive functioning.

Background
The number of surgical procedures performed worldwide is large and growing. Postoperative cognitive dysfunction is a common complication associated with poor postoperative outcomes. A variety of cognitive interventions have been developed to maintain or improve cognitive function in one or more cognitive domains. Cognitive interventions have shown to be effective in healthy older populations, those with mild cognitive impairment, and those with heart failure. The impact of cognitive interventions in surgical patients after general anaesthesia is a relatively new focus of research and is therefore less well established.

Methods
Seven bibliographic databases were searched in relation to ‘surgery’ and ‘cognitive interventions’; no date or language limits were imposed. Studies including adult patients who were scheduled for, or who had undergone surgery under general anaesthesia, had a baseline cognitive assessment using a validated measurement, and had engaged with any cognition-based intervention were included. Full-text review for inclusion, quality assessment, and data extraction were undertaken independently by two authors. This study is reported in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines.

Results
A total of 550 papers were identified for possible inclusion, of which nine met the inclusion criteria and were included in the review. The majority were randomised controlled trials (RCTs) (n=6 [66.7%]). Four studies used computerised cognitive interventions, while five used traditional cognitive interventions. Most of the studies used multi-domain cognitive training focusing on two or more domains (n=7 [77.8 %]) while two studies used single-domain cognitive training. Memory (n=7 [77.8 %]) and attention (n=5 [55.6%]) were the cognitive domains most often targeted during the intervention.

Conclusions
The use of cognitive interventions demonstrated some efficacy in improving cognitive function after general anaesthesia, particularly those targeting memory.

Relevance for clinical practice
The findings of this review suggest that cognitive interventions show promise at improiving cognitive performance in patients with POCD and could be usefully implemented in clinical practice to improve patient outcomes.

What does this paper contribute to the wider global community?
- Cognitive interventions are effective in healthy older populations, those with mild cognitive impairment and those with heart failure; however, the impact of cognitive interventions in surgical patients after general anaesthesia is less well established. This review suggests that cognitive interventions show promise at improving cognitive performance in patients with POCD and could be usefully implemented in clinical practice to improve patient outcomes.
- This review highlighted the paucity of research into intervention acceptability.

Publication Type: Article
Additional Information: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. © 2022 The Authors. Journal of Clinical Nursing published by John Wiley & Sons Ltd.
Publisher Keywords: Cognitive dysfunction; Cognitive intervention; General Surgery; Memory; Postoperative cognitive complications; Systematic Review
Subjects: B Philosophy. Psychology. Religion > BF Psychology
R Medicine > RC Internal medicine > RC0321 Neuroscience. Biological psychiatry. Neuropsychiatry
R Medicine > RT Nursing
Departments: School of Health & Psychological Sciences > Nursing
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