RESUMO
Background: Changes in cognitive function are associated with increased depression and decreased quality of life (QOL). This study aimed to determine the relationship between the characteristics of geriatric patients and anesthetic management with changes in postoperative cognitive function and QOL of geriatric patients undergoing elective surgery. Methods: This prospective observational analytic multicenter study included patients aged ≥60 years who underwent elective surgery in hospitals in Indonesia. We used the whole sampling method and performed follow-up 30 days after surgery. Data were analyzed using bivariate chi-square and multivariate regression tests with a confidence interval of 95% and α=5%. Results: Among the 933 geriatric patients included in this study (55.0% female), most (59.8%) received general anesthesia. Factors including age (p<0.001, B=-0.374, odds ratio [OR]=0.688), body mass index (BMI) (p<0.05, B=0.129, OR=1.138), and physical status based on American Society of Anesthesiologists (ASA) classification (p<.001, B=-0.458, OR=0.633) were significantly associated with postoperative cognitive function. BMI (p<.001, B=-0.218, OR=1.244), absence of comorbidities (p<0.05, B=-0.312, OR=0.732), regional anesthesia (p<0.05, B=0.606, OR=1.883), and changes in cognitive function (p<0.05, B=0.288, OR=1.334) were significantly correlated with changes in postoperative QOL. Conclusion: Age, BMI, and ASA physical status were significantly associated with postoperative cognitive function in geriatric patients, whereas BMI, comorbidities, regional anesthesia, and changes in postoperative cognitive function were associated with QOL. These preoperative factors can predict postoperative cognitive function and QOL and may be useful during preoperative planning.
RESUMO
Aim: Before establishing a multidisciplinary pain center (MPC), the pain problem, healthcare professionals (HCP) perceptions, expectations and the potential challenges of MPC establishment need to be identified. Methods: A quantitative survey study of 1058 Indonesian HCPs. The study uses a national inquiry sent by the International Association for the Study of Pain (IASP) chapter for pain. Results: 99.0% of respondents had met patients with pain as the primary complaint and acute pain as the most common complaint. Insufficient pain management in Indonesian healthcare, insufficient pain epidemiological data and unaware HCP about MPC become problems of pain management in Indonesia. However, most HCP agreed that health facilities should have MPC. Financial issues (insufficient patient insurance) were considered the most important barrier for referring patients to MPC. Conclusion: The identified core problem, HCP perceptions, expectations and challenges of MPC establishment should become a consideration in the strategic planning of MPC establishment.
Multidisciplinary pain centers (MPC) provide benefits to patients, healthcare professionals (HCP) and the community in general but are not yet established in Indonesia and other developing countries. Before establishing a MPC, the problem in pain, HCP's perceptions, expectations and challenges in MPC establishment need to be identified. From the national survey on 1058 HCP, almost all respondents (99.0%) had met patients with pain as the primary complaint and acute pain as the most common complaint (51.2%). Insufficient pain management in Indonesian healthcare, insufficient pain epidemiological data and unaware HCP about MPC have become problems in pain management in Indonesia. However, most HCP agreed that health facilities should have pain centers as well as a center for the study of pain and recommended 'pain that requires intervention' should be referred to a MPC. Financial issues such as insufficient patient insurance was considered the most important barrier for referring patients to MPCs in Indonesia. The high incidence of pain, insufficient pain management in health facilities and insufficient data on pain have become the core problem that underlies the need for MPC establishment in Indonesia. Overall, HCPs have positive perceptions and expectations regarding MPCs. Financial barriers are thought to be a potential burden in the development of MPCs. By understanding the pain problem, HCP perceptions, expectations and potential challenges on the MPC establishment, strategic planning in MPC establishment is expected to be achieved especially in developing countries.