Hongrui Zhu,1,* Zaibao Wang,1,2,* Sheng Ding,1,2,* Chunliu Li,1,2,* Li Xie,1,* Yan Meng,1 Jiawei Xiao,1,3 Wuyang Zhang,3,4 Min Xu,1 Chen Gao,1 Keqiang He,1 Sheng Wang1 

1Department of Pain and Anesthesiology, First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, People’s Republic of China; 2Graduate School of Bengbu Medical University, Bengbu, People’s Republic of China; 3Graduate Department, Wannan Medical College, Wuhu, Anhui, People’s Republic of China; 4Department of Radiology, Centre for Leading Medicine and Advanced Technologies of IHM, the First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, 230001, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Sheng Wang, Department of Anesthesiology, The First Affiliated Hospital of University of Science and Technology of China, No. 17 Lujiang Road, Luyang District, Hefei, 230001, People’s Republic of China, Email iamsheng2020@ustc.edu.cn Keqiang He, Department of Anesthesiology, The First Affiliated Hospital of University of Science and Technology of China, No. 17 Lujiang Road, Luyang District, Hefei, 230001, People’s Republic of China, Email doctorhector@ustc.edu.cn

Objective: This study aimed to compare the effects of fospropofol disodium and propofol on perioperative neurocognitive function in elderly patients undergoing total hip arthroplasty (THA), evaluating the non-inferiority of fospropofol disodium in preventing or reducing perioperative neurocognitive disorders (PND) and exploring optimal clinical anesthesia strategies.
Methods: A total of 180 elderly patients (aged 65~80 years) scheduled for THA between November 2022 and November 2024 were randomly assigned to the fospropofol disodium group (Group F, n=90) or the propofol group (Group P, n=90). Cognitive function was assessed preoperatively (1 day before surgery) and postoperatively (1, 3, 7 days, and 1 month) using the Modified Mini-Mental State Examination (MMSE), 3-Minute Diagnostic Interview for Confusion Assessment Method (3D-CAM), Digit Span Test (DST), Verbal Fluency Test (VFT), and Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE). The incidence of postoperative cognitive dysfunction (POCD) and delirium (POD), hemodynamic parameters, and adverse events were compared between the two groups.
Results: No significant differences were observed between the two groups in the incidence of POCD (p> 0.05) or POD (p> 0.05) at any postoperative time point. At the time point of 10 minutes after bone cement implantation (T4), the heart rate of patients in the Group F was higher than that of Group P (p < 0.0001). At the time of discharge from the PACU, the heart rate of patients in the Group F was lower than that of the Group P (p = 0.037). Group F exhibited higher mean arterial pressure (MAP) at the beginning of the operation (p=0.022) and a longer extubation time and waking time (p < 0.001) but had significantly lower incidences of injection pain (p=0.018) and postoperative nausea and vomiting (p=0.037). Binary logistic regression identified age as an independent risk factor for PND [OR=1.149, p=0.006], while preoperative MMSE score was a protective factor [OR=0.693, p = 0.002].
Conclusion: Fospropofol disodium may be a viable alternative in settings where injection pain and PONV are primary concerns, provided that hemodynamic stability is actively managed in elderly THA patients, with non-inferior efficacy in preventing PND compared to propofol and fewer adverse effects. Age and preoperative cognitive function are critical predictors of PND, warranting careful consideration in perioperative management.

Keywords: fospropofol disodium, propofol, perioperative neurocognitive disorders, total hip arthroplasty