The relationship between intraoperative cerebral oximetry and postoperative delirium in patients undergoing off-pump coronary artery bypass graft surgery: a retrospective study

Abstract

Background Cerebral oximetry has been widely used to measure regional oxygen saturation in brain tissue, especially during cardiac surgery. Despite its popularity, there have been inconsistent results on the use of cerebral oximetry during cardiac surgery, and few studies have evaluated cerebral oximetry during off pump coronary artery bypass graft surgery (OPCAB). Methods To evaluate the relationship between intraoperative cerebral oximetry and postoperative delirium in patients who underwent OPCAB, we included 1439 patients who underwent OPCAB between October 2004 and December 2016 and among them, 815 patients with sufficient data on regional cerebral oxygen saturation (rSO2) were enrolled in this study. We retrospectively analyzed perioperative variables and the reduction in rSO2 below cut-off values of 75, 70, 65, 60, 55, 50, 45, 40, and 35%. Furthermore, we evaluated the relationship between the reduction in rSO2 and postoperative delirium. Results Delirium occurred in 105 of 815 patients. In both univariable and multivariable analyses, the duration of rSO2 reduction was significantly longer in patients with delirium at cut-offs of < 50 and 45% (for every 5 min, adjusted odds ratio (OR) 1.007 [95% Confidence interval (CI) 1.001 to 1.014] and adjusted OR 1.012 [1.003 to 1.021]; p = 0.024 and 0.011, respectively). The proportion of patients with a rSO2 reduction < 45% was significantly higher among those with delirium (adjusted OR 1.737[1.064 to 2.836], p = 0.027). Conclusions In patients undergoing OPCAB, intraoperative rSO2 reduction was associated with postoperative delirium. Duration of rSO2 less than 50% was 40% longer in the patients with postoperative delirium. The cut-off value of intraoperative rSO2 that associated with postoperative delirium was 50% for the total patient population and 55% for the patients younger than 68 years.

Association between the reactivity of local cerebral oxygen saturation after hypo-to-hypercapnic tests and delirium after abdominal surgery in older adults: A prospective study

“…It is supported by previous studies which showed that brain hypoxemia during surgery was associated with postoperative delirium (21)(22)(23). Wang et al (32) used the rSO2 desaturation score, calculated based on baseline rSO2 and changes in rSO2 over time (39)(40)(41), and showed that the rSO2 desaturation score was associated with postoperative delirium. Similar results were observed in patients undergoing cardiac surgery (42).…”

The Effect of Intraoperative Cerebral Oximetry Monitoring on Postoperative Cognitive Dysfunction and ICU Stay in Adult Patients Undergoing Cardiac Surgery: An Updated Systematic Review and Meta-Analysis

“…The duration of rSO 2 < 50% was 40% longer in patients with POD. For the prediction of POD, the cut-off value of intraoperative rSO 2 was 50% for the total patient population, and 55% for patients younger than 68 years (39). Cournoyer et al included 20 non-randomized studies in patients after cardiac arrest and concluded that a higher regional cerebral saturation is associated with improved resuscitation outcomes, especially the return to spontaneous circulation (40).…”

Perioperative neurocognitive disorders: A narrative review focusing on diagnosis, prevention, and treatment

“…For example, studies reported that patients with low preoperative cerebral oxygen saturation had a higher incidence of postoperative delirium 184,185 ; intraoperative cerebral oxygen desaturation was associated with increased postoperative delirium. [62][63][64] A pairwise and network meta-analysis included 12 randomized trials with 1626 patients investigating the effect of brain near-infrared spectroscopy-based intervention; the results showed that cerebral oxygenation-guided management reduced delirium after cardiac surgery but not major noncardiac surgery. 186 Cerebral oxygenation-guided management may be helpful in patients undergoing cardiac surgery.…”