Evaluating the Incidence of Cognitive Disorder Following Off-Pump Coronary Artery Bypasses Surgery and its Predisposing Factors

Abstract

Background:Cognitive disorder is a fluctuating cognitive destruction and a common problem for hospitalized patients, which leads to loss of consciousness. It is usually accompanied with increased mortality, prolonged hospital stay, and decreased rehabilitation.Objectives:The purpose of this study was to determine risk factors associated with cognitive disorder after open-heart surgery.Patients and Methods:In total, 171 patients who had undergone off-pump open-heart surgery and lacked any history of psychiatric disorders were enrolled. Samples were selected according to a purposive sampling method. The Mini-Mental State Examination questionnaire was used for these patients to assess the incidence of cognitive disorder 24 hours after the operation in ICU and to compare creatinine level, ESR, extubation time and patients’ age in the two groups, one with postoperative cognitive disorder and the other without it. Independent T-test was used to compare the two groups regarding any history of diseases such as diabetes, hypertension and hyperlipidemia, Chi square test was used.Results:In total, 75% of patients had postoperative cognitive disorder. There was a significant association between the history of high blood pressure, C-reactive protein and preoperative creatinine levels in both cognitive disorder and control groups.Conclusions:Given the significant prevalence of postoperative cognitive disorder and significant associatio n between the history of high blood pressure, C-reactive protein and preoperative creatinine and cognitive disorder, detection of patient’s clinical symptoms may improve diagnosis, treatment and prevention of this disorder.

Diabetes is associated with risk of postoperative cognitive dysfunction: A meta‐analysis

“…Of the 14 studies, 13 had prospective observational designs; 1 randomized controlled trial compared cognitive outcomes between on‐pump and off‐pump coronary artery bypass grafting and analyzed their data with adjustment for surgery type . A single investigation was on glycemic control in a sample of 124 patients with diabetes; all other studies investigated POCD according to diabetes status and enrolled a total of N = 2990 patients of which N = 2518 were retained for follow‐up (see Table ). Publication dates spanned 2001 to 2015, and studies stemmed from countries in Europe, Asia, North America, and Australia.…”

“…Forrest plot for fixed‐effects meta‐analysis of diabetes and risk of POCD. Disparity in decimal places of confidence intervals compared with original reporting (0.01 to 0.02) presumably due to rounding. POCD, postoperative cognitive dysfunction…”

“…Pooled effects across studies with mean sample age greater than 65 years (RR, 1.74; 95% CI, 1.35–2.24; I 2 =26%) were larger compared with studies with mean sample age ≤ 65 years, which again were affected by a substantial degree of heterogeneity (RR, 1.20; 95% CI, 1.04–1.39; I 2 = 65%; meta‐regression, P = .032; see Figure S3). However, sensitivity analyses showed that the difference in pooled effects between studies with mean age greater than 65 versus less than or equal to 65 years appeared to be driven by a single study in the less than or equal to 65 years group (see Table S1). Neither proportion of males nor surgery type were significant moderators of the association of diabetes with POCD risk (all meta‐regression, P > .05; subgroup I 2 range from 0% to 72%; see Figures S4 and S5).…”

“…Pooled effects across studies with mean sample age greater than 65 years (RR, 1.74; 95% CI, 1.35-2.24; I 2 =26%) were larger compared with studies with mean sample age ≤ 65 years, which again were affected by a substantial degree of heterogeneity (RR, 1.20; 95% CI, 1.04-1.39; I 2 = 65%; meta- FIGURE 2 Forrest plot for fixed-effects meta-analysis of diabetes and risk of POCD. Disparity in decimal places of confidence intervals compared 21,22,31,38 with original reporting (0.01 to 0.02) presumably due to rounding. POCD, postoperative cognitive dysfunction FIGURE 3 Funnel plot for meta-analysis of diabetes and risk of POCD.…”

“…POCD, postoperative cognitive dysfunction regression, P = .032; see Figure S3). However, sensitivity analyses showed that the difference in pooled effects between studies with mean age greater than 65 versus less than or equal to 65 years appeared to be driven by a single study in the less than or equal to 65 years group 38 (see Table S1). Neither proportion of males nor surgery type were significant moderators of the association of diabetes with POCD risk (all metaregression, P > .05; subgroup I 2 range from 0% to 72%; see Figures S4 and S5).…”