European Journal of Cardiovascular Medicine

Post-operative cognitive dysfunction (POCD) describes objectively measured cognitive decline after anaesthesia and surgery and has historically been reported in 10–40% of older adults at early time points, with a smaller proportion persisting at 3–12 months. Since 2018, expert consensus recommends the umbrella term “perioperative neurocognitive disorders” (PND), aligning perioperative phenomena with DSM-5 and neurology conventions; early deficits within 30 days are termed “delayed neurocognitive recovery,” and persistent impairment up to 12 months is “post-operative neurocognitive disorder.”[1] The original ISPOCD trial series established POCD as a clinically relevant outcome after non-cardiac surgery in the elderly and highlighted age and perioperative physiological disturbances as potential contributors.[2–3] Subsequent reviews emphasize multifactorial

 

mechanisms—neuroinflammation, microembolism, patient vulnerability—and the importance of standardized testing and nomenclature.[4–6]

Clinically, PND is distinct from postoperative delirium (POD), an acute, fluctuating disturbance of attention and awareness that peaks in the first days after surgery; however, both conditions may coexist and portend worse outcomes, including prolonged hospitalization and functional decline.[5–6] Patient perspectives research suggests growing awareness of delirium but limited understanding of longer-horizon cognitive changes, underscoring the need for preoperative counselling.[7] Within Asia, surveys indicate variable knowledge and practice regarding POD/PND among anaesthesiologists and heterogeneity in screening and prevention protocols.[8] Indian evidence is predominantly clinical (incidence/risk-factor) rather than provider-focused awareness; robust national data on anaesthesiologists’ knowledge, attitudes, and practices (KAP) around POCD/PND are lacking.[4,8]

Given India’s rapidly ageing surgical population and diverse practice environments (teaching hospitals vs freelance practice across public/private sectors), quantifying awareness and practice patterns is critical to inform targeted education and implementation. We therefore conducted a nationwide cross-sectional survey to (i) estimate awareness/knowledge of POCD/PND among anaesthesiologists, and (ii) compare practices between medical-college–based clinicians and freelancers. We hypothesized that academic affiliation and prior CME exposure would be associated with better knowledge and adoption of evidence-based practices.

Key background sources supporting nomenclature, incidence, mechanisms and practice variability include Evered et al. 2018 (nomenclature), ISPOCD studies, Kotekar et al. (reviews, Indian context), and regional surveys.[1–8] (PubMed, PMC, EKJA, BJA Anaesthesia, MDPI)

Study design and setting Analytical cross-sectional, web-based survey of practising anaesthesiologists in India across public and private sectors, including medical-college faculty/residents and freelancers. Participants and sampling Eligibility: MBBS with anaesthesiology training (DA/DNB/MD/DM or equivalent), currently practising in India. Exclusions: exclusively non-clinical roles. We disseminated the survey via professional bodies’ mailing lists and social media (snowballing permitted). To estimate a conservative 50% adequate-knowledge prevalence at 95% confidence with 5% precision, the required sample was 384; anticipating 20% incomplete responses, the target sample was ≥480. Instrument development A 48-item questionnaire covered demographics; knowledge (20 single-best-answer items across definition/nomenclature, risk factors, screening tools, outcomes); attitudes (perceived importance, consent, resource prioritization); and practices (pre-operative cognitive screening, intra-operative strategies, post-operative surveillance, follow-up). Items were drafted from consensus documents and reviews, and refined by a six-member expert panel (2 academic anaesthesiologists, 1 neuropsychologist, 1 geriatrician, 2 perioperative medicine specialists). Cognitive interviewing (n=10) tested clarity. Pilot testing (n=30) informed minor edits. Validity and reliabilityContent validity index (CVI) >0.80 was required for inclusion. Internal consistency for dichotomous knowledge items was assessed by Kuder–Richardson-20 (KR-20). Construct validity was explored by known-groups comparison (academic vs freelance). Outcomes Primary: “adequate knowledge” (≥70% correct across 20 items). Secondary: (i) routine pre-operative cognitive screening (e.g., MMSE/MoCA), (ii) inclusion of POCD/PND risk in informed consent, (iii) use of delirium screening tools post-operatively (e.g., 3D-CAM/CAM-ICU), and (iv) adoption of evidence-based prevention bundles. Data collection and ethics Anonymous responses were collected over eight weeks. Participation was voluntary with electronic informed consent. The study was approved by an Institutional Ethics Committee. Statistical analysis Analyses used standard descriptive statistics. Group comparisons used χ² or Mann–Whitney U as appropriate. Variables with p<0.10 in bivariable analyses entered a multivariable logistic regression for adequate knowledge (enter method; collinearity diagnostics performed). Model fit was assessed by Hosmer–Lemeshow and c-statistic. Two-sided α=0.05.