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Postoperative cognitive dysfunction in abdominal surgery: risk factors and prevention


Author: Severin Ghenadie
Degree:doctor of medicine
Speciality: 14.00.37 - Anaesthesiology and Reanimathology
Year:2020
Scientific advisers: Adrian Belîi
doctor habilitat, professor, Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova
Bodolea Constantin
doctor în științe medicale, conferențiar universitar, UMF „Iuliu Hațieganu”, Cluj Napoca, România
Institution: Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova

Status

The thesis was presented on the 15 October, 2020
Approved by NCAA on the 23 December, 2020

Abstract

Adobe PDF document – 0.94 Mb / in romanian

Thesis

CZU 616.89-008.45-02:616.366-089.87

Adobe PDF document 3.20 Mb / in romanian
157 pages

Keywords

postoperative cognitive dysfunction, neurocognitive testing, abdominal surgery

Summary

Structure of the thesis: The thesis is composed of: introduction, four chapters, general conclusions and recommendations, bibliography of 166 titles, 2 annexes, 120 basic text pages, 13 figures and 24 tables. The obtained results are published in 13 scientific papers.

Purpose of the study: Elaboration of diagnostic criteria, identification of risk factors, specific preventive measures in postoperative cognitive dysfunction in minimally invasive abdominal surgery in young people.

Research objectives: (1) To identify cut-off values (normal vs. abnormal) by pre- and postoperative neurocognitive testing, with the development of diagnostic criteria in young people with postoperative cognitive dysfunction. (2) To estimate the prevalence and persistence of postoperative cognitive dysfunction in young patients after minimally invasive surgery on the abdomen. (3) To establish risk factors for postoperative cognitive dysfunction in young patients in minimally invasive abdominal surgery. (4) To evaluate the quality of life of young patients with postoperative cognitive dysfunction at 6 months after minimally invasive surgery on the abdomen, arguing preventive strategies and managing risk factors in postoperative cognitive dysfunction.

Scientific novelty and originality: Were identified cut-off values (normal vs. abnormal) for 5 studied ncognitive tests. The diagnostic criteria for POCD in young patients were established after minimally invasive surgery on the abdomen. The prevalence of POCD was estimated, specific risk factors were identified and preventive measures were developed.

The result obtained that contributes to solving the important scientific problem in the thesis: It consists in arguing the diagnostic criteria for postoperative cognitive dysfunction, which allowed the demonstration that POCD can occur in young people after 4-7 days after minimally invasive intervention on the abdomen, has a persistence till 6 months, affecting the quality of life for 6 months.

Theoretical significance: It consists in the elaboration of the neurocognitive testing methodology, with the identification of test cut-off values, wich led to argumentation of diagnostic criteria for POCD.

Applicative value: Based on the criteria and diagnostic methodology developed, the practitioner can identify specific risk factors and establish the diagnosis of POCD. The application of recommended preventive strategies reduces probability of POCD or reduces its duration and intensity.

Implementation of scientific results: The research results were implemented in the clinical practice of the Institute of Emergency Medicine and the Municipal Clinical Hospital no. 1 from Chisinau, as well as in the didactic activity of Nicolae Testemitanu SUMPh.