Introduction Postoperative cognitive decline (POCD) can occur in up to 60% of patients in the first month after surgery. POCD has been linked to poorer quality of life and increased mortality. It has not yet been thoroughly explored in Gynecologic Oncology. Studying its incidence may inform future efforts to mitigate functional decline after surgery.

Methods This observational cohort study involved twenty-four patients aged ≥ fifty-five undergoing surgery for a gynecologic malignancy from February to July 2022. Semi-structured interviews and the Mini Mental State Exam were administered before and one- and three-months after surgery. Assessments were delivered virtually and in-person owing to the COVID-19 pandemic. Using previous literature, POCD was defined as ≥ two-point decline from baseline.

Results Eighteen participants completed the one-month follow-up, and fifteen completed the three-month follow-up. Average age was 64, three patients underwent surgery for endometrial cancer, and thirteen for ovarian cancer. Two patients received chemotherapy before surgery; six received it after. No patients experienced postoperative delirium. Mean baseline MMSE virtual and in-person scores were 16.6 out of 17 and 12.9 out of 13, respectively. Two patients had a one-point decline at one month; both recovered by three-months. One patient had a one-point decline at three-months. Semi-structured interviews revealed common themes of ‘brain fog’ at one-month and mild, persistent attention and word-finding deficits at three-months.

Conclusion/Implications This study captured subtle qualitative themes suggestive of potential POCD. Larger studies and more extensive neuropsychological batteries may further characterize the POCD in Gynecologic Oncology, and elicit subtle findings not clearly reflected on MMSE scores.