Incidence and risk factors for early postoperative cognitive decline after coronary artery bypass grafting

Abstract

Background. The aim of our study was to evaluate the incidence of early postoperative cognitive decline (POCD) and determine perioperative risk factors as well as the impact of asymptomatic cerebral vascular lesion on the development of neurocognitive complications. Materials and methods. A total of 127 consecutive adult patients undergoing on-pump coronary artery bypass grafting were studied. Neuropsychological testing was performed the day before surgery and 7–9 days after operation. Stepwise logistic regression analysis determined independent predictors of POCD. Results. The incidence of postoperative cognitive decline was 46% (n=59). Patients in the POCD group were older (P=0.04) and had an increased prevalence of asymptomatic carotid artery stenosis (P=0.0001). POCD was associated with longer time in surgery (P=0.018), inotropic support intraoperativelly (P=0.02) and during postoperative period (P=0.008). Patients in the POCD group had an increased incidence of postoperative bleeding (P=0.037), delirium (P=0.016) and stayed in hospital for a longer period (P=0.007). Age of more than 65 years (OR, 2.7), asymptomatic carotid artery stenosis of more than 50% (OR, 26.89), duration of surgery of more than 4 hours (OR, 4.08), postoperative mechanical ventilation of more than 6 hours (OR, 3.33), and stay in an intensive care unit for more than 3 days (OR, 3.38) were significant independent predictors of cognitive decline. Conclusions. Increased age, preoperative prevalence of craniocervical atherosclerotic lesions, longer time in surgery, longer stay in an intensive care unit and mechanical ventilation time were found to be the risk factors for developing postoperative cognitive decline.

Perioperative inflammatory response and protein S‐100β concentrations – relationship with post‐operative cognitive dysfunction in elderly patients

“…Although the underlying mechanisms leading to POCD remain unclear, risk factors including age, prolonged duration of surgery, respiratory complications, and second operation are thought to be contributors . Surgical trauma can increase the level of inflammatory cytokines such as interleukin (IL)‐1β, IL‐6, tumour necrosis factor‐α (TNF‐α), and C‐reactive protein (CRP) in the peripheral and central nervous system (CNS) and impair cognitive function .…”

Validation of the Confusion Assessment Method in Detecting Postoperative Delirium in Cardiac Surgery Patients

“…[1][2][3] Delirium can lead to complications, prolonged hospitalization, and increased morbidity and mortality. [4][5][6][7] Early detection, prevention, and treatment are important for a quick postoperative recovery. [8][9][10] Delirium is a neuropsychiatric syndrome characterized by attention disturbance and a change in cognition.…”

Late Cognitive Impairment After Coronary Bypass Graft Surgery: Opportunities in Rehabilitation with the Use of Computer-Based Training

“…The inclusion criteria for the treatment group included: was in the range of 4 to 47%. However, other works reported a higher frequency of neuropsychological impairment in the early postoperative period (from 30 to 83%) [8,9]. Research over the last fi ve years indicates that the frequency of development of early POCD remains rather high -from 38 to 60% in 2 weeks and from 30 to 40% -in 8-10 weeks after CABG [10 -12].…”