{
  "abstract": "Background and objectives: 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.\n\nMethods: 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.\n\nResults: 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.\n\nConclusions: 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.\n\nSupplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s12877-026-08095-1.",
  "abstract_shown": true,
  "affiliations": [
    "Division of Gastroenterology and Hepatology, Department of Internal Medicine, Dali Branch, Jen-Ai Hospital, Taichung, Taiwan",
    "College of Medicine, Chang Gung University, Taoyuan, Taiwan",
    "Department of Gastroenterology and Hepatology, Liver Research Unit, Keelung Branch, Chang Gung Memorial Hospital, Keelung, Taiwan",
    "Community Medicine Research Center, Keelung Branch, Chang Gung Memorial Hospital, Keelung, Taiwan",
    "Liver Research Center, Linkou Branch, Chang Gung Memorial Hospital, Taoyuan, Taiwan",
    "Department of Urology, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan, Taiwan",
    "Division of Oral and Maxillofacial Surgery, Department of Dentistry, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan",
    "School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan",
    "Department of Cardiovascular Surgery, Taichung Tzu Chi Hospital, Taichung, Taiwan",
    "Department of Surgery, School of Medicine, Tzu Chi University, Hualien, Taiwan",
    "Department of Hemato-Oncology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan",
    "Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan",
    "Graduate Institute of Business Administration, College of Management, Fu Jen Catholic University, Taipei, Taiwan",
    "Artificial Intelligence Development Center, Fu Jen Catholic University, Taipei, Taiwan",
    "Department of Food Nutrition and Health Biotechnology, College of Medical and Health Science, Asia University, Taichung, Taiwan",
    "Big Data Center, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan, Taiwan",
    "Division of Radiation Oncology, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan, Taiwan",
    "Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan",
    "Cancer Center, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan, Taiwan",
    "Centers for Regional Anesthesia and Pain Medicine, Taipei Municipal Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan"
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 8,
  "authors": [
    {
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        0,
        1,
        2,
        3,
        4
      ],
      "name": "Chih-Lang Lin"
    },
    {
      "affs": [
        5
      ],
      "name": "Shyh-Chyi Chang"
    },
    {
      "affs": [
        6,
        7
      ],
      "name": "Kuan-Chou Lin"
    },
    {
      "affs": [
        8,
        9
      ],
      "name": "Jung-Min Yu"
    },
    {
      "affs": [
        10,
        11
      ],
      "name": "Chia-Lun Chang"
    },
    {
      "affs": [
        6,
        7
      ],
      "name": "Chih-Yuan Fang"
    },
    {
      "affs": [
        12,
        13
      ],
      "name": "Wan-Ming Chen"
    },
    {
      "affs": [
        14,
        15,
        16,
        17,
        18,
        19
      ],
      "name": "Szu-Yuan Wu",
      "orcid": "0000-0001-5637-558X"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/6cvgwv3a3p41e.bib",
  "cited_by": 0,
  "doi": "10.1186/s12877-026-08095-1",
  "fulltext_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13741560/",
  "id": "6cvgwv3a3p41e",
  "issns": [
    "1471-2318"
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  "landing_url": "https://doi.org/10.1186/s12877-026-08095-1",
  "language": "en",
  "licence": "CC-BY-NC-ND-4.0",
  "licence_label": "CC BY-NC-ND 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc-nd/4.0/",
  "metadata_licence": null,
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      "2806|Anesthesia and Neurotoxicity Research"
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  "pdf_url": null,
  "pmcid": "PMC13741560",
  "pmid": "42995535",
  "published": "2026-08-08",
  "publisher": "BMC",
  "ris": "https://research.draconitic.com/paper/6cvgwv3a3p41e.ris",
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    {
      "first_seen": "2026-11-10T12:22:35Z",
      "native_id": "PMC13741560",
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  "subjects": [
    {
      "field": "biology",
      "origin": "openalex:2806|Anesthesia and Neurotoxicity Research",
      "subfield": "neuroscience"
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  ],
  "title": "Same-day EHR-coded sevoflurane versus propofol exposure and long-term coded dementia in older surgical adults: a propensity-matched cohort study",
  "title_text": "Same-day EHR-coded sevoflurane versus propofol exposure and long-term coded dementia in older surgical adults: a propensity-matched cohort study",
  "type": "peer-reviewed",
  "updated_at": "2026-11-10T12:22:35Z",
  "url": "https://research.draconitic.com/paper/6cvgwv3a3p41e",
  "venue": "BMC Geriatrics",
  "versions": []
}