# Low serum triglycerides related to delayed neurocognitive recovery in geriatric oral and maxillofacial surgery patients: A prospective cohort study

## TL;DR

Low levels of specific triglycerides in the blood are linked to slower recovery of brain function after surgery in older patients.

## Contribution

Identifies specific triglycerides as early biomarkers for delayed neurocognitive recovery in geriatric oral surgery patients.

## Key findings

- Preoperative low TG(58:7/22:5) and TG(54:2/18:1) levels strongly predict delayed neurocognitive recovery.
- Postoperative low levels of the same triglycerides retain predictive value for delayed recovery.
- The biomarkers show high sensitivity and specificity for identifying at-risk patients.

## Abstract

Geriatric patients undergoing oral and maxillofacial surgery are at high risk of delayed neurocognitive recovery (dNCR), yet reliable predictive tools remain unavailable.

This prospective cohort study (July 2021–January 2025) enrolled patients aged ≥ 65 undergoing elective oral and maxillofacial surgery under general anaesthesia. Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) were assessed at baseline and postoperative 1, 3, 7, and 30 days. Serum lipidomics analysis via liquid chromatography-mass spectrometry was performed preoperatively and 24 h postoperatively. The predictive performance of lipid metabolites for dNCR was assessed using receiver operating characteristic curve analysis, with their independent association further evaluated by logistic regression.

Among 160 patients, 52 patients (32.5%) developed dNCR. Preoperatively, dNCR patients exhibited significantly lower serum triglyceride (TG), particularly TG(58:7/22:5) (OR = 0.014, 95% CI 0.002 to 0.109, adjusted P < 0.001) and TG(54:2/18:1) (OR = 0.051, 95% CI 0.010 to 0.252, adjusted P = 0.002), which demonstrated strong predictive performance (AUC = 0.86, sensitivity = 0.73, specificity = 0.85). Postoperatively, reduced levels of TG(58:7/22:5) (OR = 0.067, 95% CI 0.015 to 0.309, adjusted P = 0.003) and TG(54:2/18:1) (OR = 0.034, 95% CI 0.006 to 0.176, adjusted P < 0.001) persisted in dNCR patients at 24 h, retaining predictive value for dNCR (AUC = 0.82, sensitivity = 0.75, specificity = 0.78).

Low serum TG(58:7/22:5) and TG(54:2/18:1) are promising biomarkers for early prediction of dNCR, supporting lipidomics-guided perioperative neurocognitive risk stratification.