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Peer-reviewedCC BY-NC-ND 4.0BMC Geriatrics

Same-day EHR-coded sevoflurane versus propofol exposure and long-term coded dementia in older surgical adults: a propensity-matched cohort study

  • Chih-Lang Lin1,2,3,4,5
  • Shyh-Chyi Chang6
  • Kuan-Chou Lin7,8
  • Jung-Min Yu9,10
  • Chia-Lun Chang11,12
  • Chih-Yuan Fang7,8
  • Wan-Ming Chen13,14
  • Szu-Yuan Wu15,16,17,18,19,20
20 affiliations
  1. 1Division of Gastroenterology and Hepatology, Department of Internal Medicine, Dali Branch, Jen-Ai Hospital, Taichung, Taiwan
  2. 2College of Medicine, Chang Gung University, Taoyuan, Taiwan
  3. 3Department of Gastroenterology and Hepatology, Liver Research Unit, Keelung Branch, Chang Gung Memorial Hospital, Keelung, Taiwan
  4. 4Community Medicine Research Center, Keelung Branch, Chang Gung Memorial Hospital, Keelung, Taiwan
  5. 5Liver Research Center, Linkou Branch, Chang Gung Memorial Hospital, Taoyuan, Taiwan
  6. 6Department of Urology, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan, Taiwan
  7. 7Division of Oral and Maxillofacial Surgery, Department of Dentistry, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
  8. 8School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
  9. 9Department of Cardiovascular Surgery, Taichung Tzu Chi Hospital, Taichung, Taiwan
  10. 10Department of Surgery, School of Medicine, Tzu Chi University, Hualien, Taiwan
  11. 11Department of Hemato-Oncology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
  12. 12Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
  13. 13Graduate Institute of Business Administration, College of Management, Fu Jen Catholic University, Taipei, Taiwan
  14. 14Artificial Intelligence Development Center, Fu Jen Catholic University, Taipei, Taiwan
  15. 15Department of Food Nutrition and Health Biotechnology, College of Medical and Health Science, Asia University, Taichung, Taiwan
  16. 16Big Data Center, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan, Taiwan
  17. 17Division of Radiation Oncology, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan, Taiwan
  18. 18Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan
  19. 19Cancer Center, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan, Taiwan
  20. 20Centers for Regional Anesthesia and Pain Medicine, Taipei Municipal Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
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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.

Methods: 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.

Results: 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.

Conclusions: 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.

Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s12877-026-08095-1.

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Cite

BibTeXRIS
BibTeX
@article{lin2026sameday,
  title = {{Same-day EHR-coded sevoflurane versus propofol exposure and long-term coded dementia in older surgical adults: a propensity-matched cohort study}},
  author = {Chih-Lang Lin and Shyh-Chyi Chang and Kuan-Chou Lin and Jung-Min Yu and Chia-Lun Chang and Chih-Yuan Fang and Wan-Ming Chen and Szu-Yuan Wu},
  journal = {BMC Geriatrics},
  year = {2026},
  month = aug,
  doi = {10.1186/s12877-026-08095-1},
  url = {https://doi.org/10.1186/s12877-026-08095-1},
  note = {CC BY-NC-ND 4.0},
}
RIS
TY  - JOUR
TI  - Same-day EHR-coded sevoflurane versus propofol exposure and long-term coded dementia in older surgical adults: a propensity-matched cohort study
AU  - Chih-Lang Lin
AU  - Shyh-Chyi Chang
AU  - Kuan-Chou Lin
AU  - Jung-Min Yu
AU  - Chia-Lun Chang
AU  - Chih-Yuan Fang
AU  - Wan-Ming Chen
AU  - Szu-Yuan Wu
PY  - 2026
DA  - 2026/08/08
JO  - BMC Geriatrics
DO  - 10.1186/s12877-026-08095-1
UR  - https://doi.org/10.1186/s12877-026-08095-1
AB  - 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.  Methods: 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.  Results: 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.  Conclusions: 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.  Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s12877-026-08095-1.
SN  - 1471-2318
ER  -