Impact of placenta accreta spectrum and cesarean hysterectomy on quality of life and postpartum depression: a case-control study in Shiraz, Iran.

Cognitive impairment occurring within the first month after surgery is defined as delayed neurocognitive recovery (DNR), which is characterized by objective deficits in attention, memory, and information processing abilities []. DNR can occur in individuals of any age [], with 30%–75% of patients exhibiting DNR at the time of hospital discharge [–]. Older patients are at a higher risk of DNR due to age-related degenerative changes in brain function and structure []. Studies have demonstrated that individuals aged 60 years and above have a significantly higher incidence of DNR than younger populations []. DNR is associated with poor postoperative functional recovery, prolonged hospital stays, increased complications, and higher mortality rates, imposing a substantial burden on patients, families, and society []. Therefore, while no definitive personalised interventions have yet been proven to reduce the incidence of DNR, increased awareness and targeted monitoring of high-risk individuals during the perioperative period may still be beneficial. Previous studies have shown that the preoperative risk factors for DNR include advanced age, a low education level, and the burden of comorbidities []. Intraoperative risk factors for DNR may be related to surgery-induced disturbances in the internal environment []. These disturbances activate innate immune cells, triggering a systemic inflammatory response that promotes the release of inflammatory cytokines and subsequent neuroinflammation, leading to nerve damage and cognitive decline [, ]. Additionally, the incidence of DNR varies significantly by the type of surgery. For example, the incidence of DNR in cardiac surgery has been reported to be as high as 60%, compared to 41.4% in non-cardiac surgery [, ]. Furthermore, the incidence of DNR among cardiac procedures was found to be the highest after open aortic surgery, transcatheter aortic valve implantation, and coronary artery bypass grafting []. These studies suggest that different types of surgery may cause varying degrees of disruption to the body’s internal environment, and thus varying rates of DNR. Although multiple risk factors for DNR have been reported in various studies [, ], the underlying risk factors for the development of DNR associated with major orthopedic surgery, such as joint replacement or lumbar interbody fusion, remain poorly understood. These surgeries pose significant risks to patients, highlighting the need for early recognition of high-risk individuals and the use of targeted mitigation strategies to improve patient outcomes. As the prevalence of age-related degenerative changes in the joints and lumbar spine increase, a growing number of elderly patients are undergoing major orthopedic surgery []. Studies have reported that the incidence of DNR in the early postoperative period in elderly patients undergoing major orthopedic surgery can reach 25%–50% [–]. However, there is limited research on the risk factors for DNR in such patients. This study aimed to examine the factors contributing to early postoperative DNR in elderly individuals aged 65 years or above who underwent major orthopedic procedures. The identification of these potential risk factors may help raise clinical awareness of individuals at higher risk of DNR and serve as a foundation for future studies exploring targeted perioperative strategies.