One of the most common post-op complications among the elderly
Description of condition: Post operative cognitive decline (POCD) is a common neuropsychiatric syndrome, temporally associate with surgery and defined as disturbance of attention, awareness and cognition, which develops over a short period of time and tends to fluctuate during the course of the day.
Patients with hip fracture are at particularly high risk of developing POCD. The United Kingdom’s national audit data for 2018 showed that 25% of all patients with hip fracture suffered from delirium. POCD is associated with poor functional outcomes, reduced quality of life and longer hospital stays. People with hip fracture who developed delirium are twice as likely to die as inpatients, and nearly four times more likely to need placement in a nursing home. POCD has also been closely associated with long-term cognitive impairment.
According to various studies, POCD is developed in 13-40% of patients following cardiac surgery. With 500,000 open-heart surgeries and 450,000 hip surgeries in the USA each year, in advanced age patients, a beneficial therapy to treat POCD would be a significant benefit to these patients.
Current standard of care: Currently, there are no medications or treatments for POCD. The best treatment for POCD is prevention, with early recognition and management of potential perioperative risk factors. Preventive strategies should involve close collaboration between surgeons, anesthesiologists, and geriatricians in order to reduce the total hospital stay by choosing the optimum surgical technique of short duration as a means to decrease inflammatory response. Advanced age has been considered as an independent risk factor. The other risk factors for developing POCD include larger and more invasive operations, duration and depth of anesthesia, hypotension, and cerebral anoxia. Intraoperative anesthetic monitoring of the depth of anesthesia can benefit the elderly by reducing the chances of developing POCD.
Our solution: Promising research findings in this field have provided insight into the possible role inflammation plays in POCD. There is strong clinical evidence for anti-TNF as a preventative therapy. We plan to initiate a Phase 2, multi-center trial of pre-operative anti-TNF in hip fracture surgery by 2024, with a single dose administered just prior to surgery. An issued patent to protect this potential use has been licensed from The Kennedy Trust for Rheumatology Research.