For many older adults, major surgery can bring important benefits.
Procedures such as hip replacements can reduce pain and improve mobility, while abdominal surgeries can treat serious medical conditions and improve quality of life.
However, a growing body of research suggests that surgery may affect more than just the body. It may also have lasting effects on the brain.
A new study published in the Journal of the American Geriatrics Society has found that some older adults experience significant declines in memory and thinking abilities after major surgery.
The research followed hundreds of seniors for up to six years and identified several factors that may help predict who is most at risk.
As populations around the world continue to age, understanding the long-term effects of surgery has become increasingly important. By 2030, more than one in five Americans will be over the age of 65.
Many of these individuals will face decisions about whether to undergo major operations. While surgery may offer relief from pain or improve physical function, patients and families also want to understand the possible risks.
The study was conducted using data from the Successful Aging after Elective Surgery, or SAGES, project. Researchers focused on 560 adults aged 70 and older who showed no signs of dementia before surgery. Participants underwent major non-cardiac procedures such as hip replacements and abdominal surgeries that required at least three days in the hospital.
To better understand how surgery affected the brain, the researchers followed participants for as long as six years. Before surgery, participants completed detailed tests that measured memory, attention, reasoning, and other cognitive abilities.
Researchers also monitored patients during their hospital stay for signs of delirium, a temporary condition that can cause confusion, disorganized thinking, memory problems, and difficulty paying attention.
Delirium is relatively common after major surgery, especially among older adults. A person experiencing delirium may suddenly become confused, have trouble recognizing familiar people or places, or struggle to follow conversations. Symptoms can develop quickly and may fluctuate throughout the day.
The researchers also included a comparison group of 119 older adults who did not undergo surgery. This allowed them to determine whether changes in cognition were related to surgery rather than normal aging alone.
When the researchers analyzed the data, they found three different patterns of cognitive change. About one-quarter of participants remained mentally sharp throughout the follow-up period. Their memory and thinking abilities stayed relatively stable despite aging.
The largest group, representing nearly 60 percent of participants, experienced only small declines in cognitive performance. These changes were similar to what might be expected during normal aging and did not suggest major problems.
A smaller but important group showed a very different pattern. Nearly 15 percent experienced a sharp decline in cognitive abilities shortly after surgery. More concerning, their memory and thinking skills continued to worsen over the following years. This group experienced significantly greater cognitive deterioration than the other participants.
The researchers identified three major warning signs linked to this severe decline. The first was older age. The second was lower cognitive test scores before surgery. The third, and strongest predictor, was postoperative delirium.
Patients who developed delirium after surgery were about twice as likely to experience severe long-term cognitive decline compared with patients who did not develop delirium. This finding highlights the importance of preventing, identifying, and treating delirium whenever possible.
Scientists have been studying postoperative neurocognitive disorders for decades. These conditions involve problems with memory, attention, and thinking that appear after surgery.
Previous research has linked such disorders to reduced independence, lower quality of life, and even higher mortality rates. The new study adds important evidence by showing that some patients continue to experience worsening cognitive decline for years after their operations.
The findings may help doctors better identify high-risk patients before surgery. Knowing who is most vulnerable could allow healthcare teams to take steps to reduce the risk of complications. For example, hospitals may be able to use specialized programs to prevent delirium, improve recovery, and monitor cognitive health more closely after surgery.
An analysis of the study suggests that its greatest strength is the long follow-up period and the use of detailed cognitive testing before and after surgery. The inclusion of a comparison group also strengthens the findings.
However, the study focused mainly on older adults undergoing elective non-cardiac surgery, so the results may not apply to every patient population. Future research involving larger and more diverse groups will help confirm the findings and determine the best ways to protect brain health after surgery.
Even so, the study provides valuable evidence that cognitive health should be considered alongside physical recovery when older adults are preparing for major operations.
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