.png){kind=icon}
.png){kind=icon}
Return
Same-day EHR-coded sevoflurane versus propofol exposure and long-term coded dementia in older surgical adults: a propensity-matched cohort study
.png){kind=icon}
OA
AI
C
S
K
J
C
C
W
S
DOI：10.1186/s12877-026-08095-1.png)
.png){kind=icon}
Original request for help.png){kind=icon}
Share.png){kind=icon}
Save
Abstract
En 中文
Whether perioperative EHR records of sevoflurane and propofol identify clinically meaningful differences in long-term dementia risk is uncertain. We compared same-day EHR-coded sevoflurane versus propofol exposure in relation to subsequent coded dementia among older adults undergoing major inpatient surgery. We conducted a multinational propensity-score-matched cohort study using the TriNetX federated EHR network. Adults aged 60 years or older undergoing major inpatient surgery from January 1, 2010, to December 31, 2024, were classified by a same-calendar-day record of the index procedure and sevoflurane or propofol. The aggregate export did not consistently provide route, bolus-versus-infusion status, dose, duration, or anesthesia timestamps; therefore, exposure groups were interpreted as EHR-coded patterns rather than validated exclusive maintenance regimens. The primary outcome was incident coded dementia from index + 1 day. Death was treated as censoring for the cause-specific Cox estimand. Sensitivity analyses included 90- and 180-day landmarks, a higher-specificity dementia definition, stricter exposure coding, and a 5-year dementia-or-death composite. After matching, 35,363 patients were included in each group. Matching retained 99.94% of the sevoflurane-coded cohort but 2.49% of the much larger propofol-coded cohort. Coded dementia occurred in 701 patients (1.98%) in the sevoflurane-coded group and 384 (1.09%) in the propofol-coded group (hazard ratio [HR], 1.84; 95% CI, 1.62–2.08; P < 0.001). The 5-year dementia-or-death composite occurred in 3,024 patients (8.55%) and 2,195 patients (6.21%), respectively (HR, 1.43; 95% CI, 1.33–1.52). Most measured covariates were balanced after matching, although residual imbalance remained for diastolic blood pressure and C-reactive protein. In a selected matched common-support EHR population, same-day sevoflurane-coded exposure was associated with a higher subsequent incidence of coded dementia than same-day propofol-coded exposure. Exposure misclassification, restricted overlap, residual confounding, surveillance differences, and competing mortality preclude causal inference or prescribing recommendations.
Keywords:
Anesthesia
Sevoflurane
Propofol
Dementia
Older adults
Electronic health records
Competing events
Journal
IF:
3.8
Papers:
7.9K
Citations:
2.4W
Organization
Cited Papers