Exposure to General Anesthesia and Risk of Dementia: A Nationwide Population-Based Cohort Study

Article type: Research Article

Authors: Kim, Clara Tammy^{a; 1} | Myung, Woojae^{b; 1} | Lewis, Matthew^c | Lee, Hyewon^{b; d} | Kim, Satbyul Estella^e | Lee, Kyungsang^f | Lee, Chunsoo^f | Choi, Junbae^f | Kim, Ho^{d; 2; *} | Carroll, Bernard J.^g | Kim, Doh Kwan^{f; 2; *}

Affiliations: [a] Institute of Life and Death Studies, Hallym University, Chuncheon, Gangwon-do, Republic of Korea | [b] Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, South Korea | [c] Aged Psychiatry Service, Caulfield Hospital, Alfred Health, VIC, Australia | [d] Institute of Health and Environment, Seoul National University & Department of Health Sciences, Graduate School of Public Health, Seoul National University, Seoul, South Korea | [e] Center for Social and Environmental System Research, National Institute for Environmental Studies, Tsukuba, Japan | [f] Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University School of Medicine, Gangnam-gu, Seoul, South Korea | [g] Department of Psychiatry, Emeritus, Duke University Medical Center, Durham, NC, USA

Correspondence: [*] Correspondingauthor: Doh Kwan Kim, MD, PhD, Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea. Tel.: +82 2 3410 3582; Fax: +82 2 3410 0941; E-mail: [email protected] and Ho Kim, PhD, Graduate School of Public Health, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul 151-742, Korea. Tel.: +82 2 880 2711; Fax: +82 2 745 9104; E-mail: [email protected].

Note: [1] C.T. Kim and W. Myung contributed equally to this article as co-first authors, and listed in alphabetical order.

Note: [2] These individuals contributed equally to this work as cocorresponding authors.

Abstract: Background:There is a growing concern that general anesthesia could increase the risk of dementia. However, the relationship between anesthesia and subsequent dementia is still undetermined. Objective:To determine whether the risk of dementia increases after exposure to general anesthesia. Methods:A population-based prospective cohort study analyzing the Korean National Health Insurance Service-National Sample Cohort database was conducted of all persons aged over 50 years (n = 219,423) from 1 January 2003 and 31 December 2013. Results:44,956 in the general anesthesia group and 174,469 in the control group were followed for 12 years. The risk of dementia associated with previous exposure to general anesthesia was increased after adjusting for all covariates such as gender, age, health care visit frequency, and co-morbidities (Hazard ratio = 1.285, 95% confidence interval = 1.262–1.384, time-varying Cox hazard model). In addition, the number of anesthetic agents administered, the number of exposures to general anesthesia, the cumulative exposure time, and the organ category involved in surgery were associated with risk of dementia. Conclusion:In light of the increasing societal burden of dementia, careful surveillance for dementia and prevention guidelines for patients after general anesthesia are needed.

Keywords: Anesthesia, dementia, postoperative complications, risk factor

DOI: 10.3233/JAD-170951

Journal: Journal of Alzheimer's Disease, vol. 63, no. 1, pp. 395-405, 2018