Current status and influencing factors of early delayed neurocognitive recovery in older adult patients after major orthopedic surgery under general anesthesia: a cohort study.

OBJECTIVE: To investigate the current status of early delayed neurocognitive recovery (dNCR) in older adult patients after major orthopedic surgery in China and analyze its influencing factors, providing a reference for early intervention by clinical workers. DESIGN: Observational cohort study. METHODS: A convenience sampling method was used to select patients aged 60 years or older who underwent major orthopedic surgery under general anesthesia at a tertiary hospital in Qingdao, Shandong Province, from September 2025 to June 2026. A general information questionnaire, depression scale, frailty scale, nutrition scale, and sleep quality scale were used to collect data 1 day before surgery. The Beijing version of the Montreal Cognitive Assessment (MoCA) was administered 1 day before surgery and on postoperative day 7 or before discharge (whichever occurred first). Variables with p < 0.2 in the univariate analysis were entered into the binary logistic regression model to identify factors influencing dNCR. RESULTS: A total of 505 patients were included, of whom 155 (30.69%) developed dNCR. Regression analysis showed that age, sleep disorder, anesthesia time, and stroke history were independent risk factors for postoperative dNCR, and the MoCA score was a protective factor (p < 0.05). CONCLUSION: After major orthopedic surgery, dNCR is relatively common in older adult patients. Clinical workers should strengthen early preoperative screening, identify high-risk patients, and provide targeted interventions and cognitive training, so as to improve patient outcomes.