Research

Cognitive Changes After Major Joint Replacement - Full Trial (COGNIGRAM, NCT03147937)

Postoperative cognitive dysfunction (POCD) is thought to affect a significant proportion of patients after major surgery (up to 10 per cent at 3 months). This is a condition that can occur after surgery and anaesthesia affecting memory and thought processes. Cognitive testing is not routinely done before and after major joint replacement surgery. The aim of this study is to measure the likelihood of POCD through a standardized cognitive test completed once before surgery and three times in the days and months following surgery. Based on our pilot study, we are currently recruiting a total of 600 patients to assess for cognitive changes after major joint replacements.

Dexmedetomidine to reduce the incidence of persistent cognitive dysfunction after open cardiac surgery - Multicentre Trial (NCT04289142)

Anesthesia is a drug induced reversible, comatose state that facilitates surgery. While it is widely assumed that cognition returns to baseline after anesthetics have been eliminated, many patients have persistent memory impairment for weeks to months after surgery. These cognitive deficits, termed postoperative cognitive dysfunction (POCD), are associated with significant negative health and social implications. There are no existing preventative or treatment strategies.

POCD has been reported in patients undergoing anesthetia associated with all types of surgeries, while cardiac surgeries appear to carry the highest risk. Notably, up to 80% of patients have POCD 3 weeks after cardiac surgery and up to 60% have persistent POCD at 6 months.

In this clinical trial we investigate the role of the Precedex (Dexmedetomidine) in preventing POCD up to three months after cardiac surgery and enhancing early postoperative recovery. Precedex is a drug that is used in clinical practice as a sedative and analgesic. The results of this trial will provide an insight on the efficacy of Precedex in reducing the incidence of POCD after anesthesia, and may lead to identification the first POCD preventative therapeutics.

Redesigning the surgical pathway: optimizing PReOperative assessMent in anesthesia clinic for adulT surgical patiEnts (PROMoTE, NCT05114876)

Postoperative delirium (POD), a short-term state of confusion, is a common postoperative complication affecting older adults. In addition to being stressful for patients and their families, POD is linked to longer hospital stays, health-care costs, higher mortality rates and potential risk of dementia.

While pharmacological interventions have proven ineffective, non-pharmacological strategies (ie. CHASM protocol) effectively reduce POD but are frequently under-utilized due to limited awareness and perceived barriers to implementation. Perioperative assessment of cognitive function is critical and a target for early intervention.

In this two-phase, prospective, observational clinical study in patients ≥60 scheduled to undergo major elective, non-cardiac surgery, in Phase I we will implement a telemedicine-based routine preoperative cognitive screening to identify at-risk patients, or patients with pre-existing cognitive impairment (pre-CI), which is a strong, but under-recognized POD risk factor. In Phase II, we will implement and evaluate a multicomponent delirium-reduction protocol, which includes directly informing the care team of high-risk (pre-CI) patients, implementing non-pharmacological delirium reduction strategies and a patient/caregiver education program which informs patients of cognitive risks and evidence-based delirium prevention strategies.

Collaborations

The functional improvement trajectories after surgery study (FIT After Surgery)

Around 190 million adults undergo major surgery in developed countries every year. The populations in these countries, including Canada, are aging; people ≥65 years are the fastest growing age group. Older surgical patients are more likely to be less healthy and frailer than younger surgical patients. Thus, older sicker people are now more commonly undergoing surgery.

There is currently limited data on long-term recovery in older adults after major surgery. Unfortunately, most studies have only tracked older patients for 30 days after surgery, which does not necessarily predict long-term outcomes. To address this issue, our study (FIT After Surgery) is following 2,000 older adults at 10 Canadian centres for up to a one year after major elective non-cardiac surgery. FIT will assess long-term recovery and development of significant new disability in these patients. Further, we will also identify risk factors for poor long-term outcomes.

It is important to understand the risks of surgery in order to help patients and health-care professionals make informed decisions. This study could help transform decision-making and patient care before and after major surgery.