Impact of ambient temperature on postoperative cognitive dysfunction in elderly patients surgery: A seasonal comparison in tropical regions

doi:10.5498/wjp.v15.i11.111917

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World Journal of Psychiatry

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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World J Psychiatry. Nov 19, 2025; 15(11): 111917
Published online Nov 19, 2025. doi: 10.5498/wjp.v15.i11.111917

Impact of ambient temperature on postoperative cognitive dysfunction in elderly patients surgery: A seasonal comparison in tropical regions

Mi Liu, Wen-Li Song, Hai-Jun Shen, Yun-Mian Liu

Mi Liu, Yun-Mian Liu, Center for Rehabilitation Medicine, Department of Anesthesiology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou 310000, Zhejiang Province, China

Mi Liu, Yun-Mian Liu, Research Institute of Anesthesiology and Perioperative Medicine, Hangzhou Medical College, Hangzhou 310000, Zhejiang Province, China

Wen-Li Song, Center for Rehabilitation Medicine, Department of Neurology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou 310000, Zhejiang Province, China

Hai-Jun Shen, Department of Anesthesiology, Haikou Hospital Affiliated to Xiangya Medical College, Central South University, Haikou 570000, Hainan Province, China

Co-corresponding authors: Hai-Jun Shen and Yun-Mian Liu.

Author contributions: Liu YM and Shen HJ contributed to this paper; Liu M designed the overall concept and outline of the manuscript; Liu M and Liu YM contributed to the writing, and editing the manuscript; Song WL contributed to the discussion and design of the manuscript, and review of literature. Liu YM served as the initiator and lead designer of the study. She took overall charge throughout the entire research process, from proposing the research topic and designing the overall framework of the study protocol (e.g., determining the sample inclusion criteria and experimental technical routes) to resolving key difficulties encountered during the research implementation. Shen HJ acted as the leader in providing technical support, as well as collecting and analyzing data for the study. He collected 125 research samples, obtained ethical approval for the study, and applied appropriate statistical methods to analyze the samples, thereby deriving reliable conclusions. Throughout the entire research process-from study design and implementation to manuscript writing-the two authors assumed equally important roles in communication, coordination, and decision-making. For instance, they jointly supervised the conduct of experiments, co-revised the core sections of the manuscript, and collaborated in addressing and responding to the reviewers’ comments. Furthermore, both authors bear equal responsibility for the authenticity, reproducibility of the research, and the content of the manuscript. The contributions of both authors fully meet the core responsibilities of corresponding authors, and their collaboration was a crucial guarantee for the successful completion of this study. Therefore, we design that Liu YM and Shen HJ be designated as co-corresponding authors.

Institutional review board statement: The study was reviewed and approved by the Haikou Hospital Affiliated to Xiangya Medical College, Central South University Institutional Review Board (Approval No. 2020-086).

Informed consent statement: All study participants provided informed written consent prior to study enrollment.

Conflict-of-interest statement: The authors declare no conflict of interest.

STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.

Data sharing statement: The original data is available on request from the corresponding author.

Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/

Corresponding author: Yun-Mian Liu, PhD, Center for Rehabilitation Medicine, Department of Anesthesiology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), No. 158 Shangtang Road, Hangzhou 310000, Zhejiang Province, China. yunmianliuw@163.com

Received: July 15, 2025
Revised: August 14, 2025
Accepted: September 1, 2025
Published online: November 19, 2025
Processing time: 112 Days and 12 Hours

Abstract

BACKGROUND

To investigate whether seasonal differences in ambient temperature affect the incidence of early postoperative cognitive dysfunction (POCD) among elderly patients undergoing laparoscopic surgery in tropical regions. Additionally, it explored the perioperative risk factors associated with early POCD following abdominal laparoscopic surgery.

AIM

To investigate the influence of seasonal differences in ambient temperature on POCD of elderly patients

METHODS

A total of 125 patients aged ≥ 65 years from Hainan Province, China, who underwent laparoscopic surgery under general anesthesia with tracheal intubation, were enrolled. All patients completed the Mini-Mental State Examination one day before surgery and on postoperative days 1, 3, and 7. A decline of ≥ 2 points from baseline was considered indicative of cognitive dysfunction. Serum levels of S100 calcium binding protein B and neuron-specific enolase were measured using enzyme-linked immunosorbent assay at three time points: Preoperatively, immediately after extubation, and 24 hours postoperatively. Perioperative clinical data were collected to identify potential risk factors for POCD. Propensity score matching (PSM) was performed (1:1, caliper = 0.03), resulting in 41 matched patient pairs between winter and summer groups.

RESULTS

After PSM, baseline characteristics including age, gender, body mass index, education level, comorbidities, and surgical variables were well balanced between groups. There were no significant differences in the incidence of POCD on postoperative days 1, 3, and 7 between patients undergoing laparoscopic surgery in winter vs summer. However, multivariable logistic regression revealed that surgical duration (day 1, P value = 0.049), advanced age and elevated creatinine (day 3, P value = 0.044, P value = 0.008), and hypoalbuminemia (day 3, P value = 0.042; day 7, P value = 0.015) were independently associated with early POCD.

CONCLUSION

Ambient temperature differences between winter and summer in tropical regions did not significantly affect the incidence of early POCD in elderly patients undergoing laparoscopic surgery. Nonetheless, age, longer surgical duration, elevated creatinine, and hypoalbuminemia emerged as key risk factors. These findings underscore the importance of perioperative optimization to reduce the risk of POCD in elderly patients, regardless of seasonal temperature variations.

Keywords: Tropical region; Seasonal variation; Ambient temperature; Postoperative cognitive dysfunction; Elderly; Laparoscopic surgery; Risk factors

Core Tip: The first part aims to evaluate whether there is a difference in the incidence of postoperative cognitive dysfunction (POCD) between elderly patients undergoing laparoscopic surgery in winter compared to summer in a tropical region. Given that the etiology and pathogenesis of POCD remain unclear, this study will help clarify the impact of environmental temperature changes on POCD in elderly patients. The second part focuses on analyzing the risk factors for POCD in elderly patients undergoing laparoscopic surgery in a tropical region. This will provide new research perspectives for exploring the pathogenesis of POCD and offer feasible and effective intervention measures to prevent the onset and progression of POCD.