ArticleBMC geriatrics2026
Same-day EHR-coded sevoflurane versus propofol exposure and long-term coded dementia in older surgical adults: a propensity-matched cohort study.
Article in BMC geriatrics, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
BACKGROUND AND
objectivesWhether 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.
methodsWe 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.
resultsAfter 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.
conclusionsIn 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.
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