Analyzing impact of long COVID on cognitive health, surgical outcomes

Editor's Note

The term "perioperative neurocognitive disorder" has been adopted to describe cognitive impairments identified during the perioperative period, the American College of Surgeons (ACS) May 8 reports. Postoperative delirium, in particular, is an acute complication manifesting as confusion and fluctuating levels of consciousness and attention. The incidence of this condition is variable, influenced by factors like age, preexisting cognitive issues, and educational background.

The American Society of Anesthesiologists and other associations emphasize the importance of preoperative cognitive assessments, which are not often conducted, thus leading to gaps in patient care and prevention strategies. High incidents of “brain fog” brought on by long COVID make the need for this assessment all the more critical.

As of 2022, an estimated 77% of the US population has been infected with COVID-19 (SARS-CoV-2). Among these, around 30% report persistent symptoms known as long COVID, with 11% still experiencing issues after 6 months. A key complaint among these patients is "brain fog," which includes cognitive difficulties such as diminished capabilities in memory, attention, and processing speed when compared to those without long COVID. The condition is possibly caused by a prolonged, subclinical infection creating a viral reservoir, potentially in the gut. This reservoir might influence immune responses and contribute to ongoing cognitive symptoms.

Surgical procedures in long COVID patients pose additional risks, including the potential spread of the virus to other tissues and an exacerbation of autoimmunity due to tissue damage during surgery. Moreover, mitochondrial dysfunction observed in these patients could extend recovery times post-surgery. To address these challenges, ACS suggests surgeons engage in enhanced diagnostic testing, such as checking for viral presence in nasopharynx and stool samples of long COVID patients. Preoperative administration of treatments like nirmatrelvir/ritonavir (Paxlovid) might be considered to clear persistent infections and mitigate symptoms.

Referral to specialized long COVID clinics for comprehensive assessment and management before surgery is another recommended strategy. These clinics, available across various medical centers, can provide insights into both cognitive and noncognitive symptoms of long COVID, assisting in better surgical planning and patient care.