Effect of preoperative cognitive dysfunction on postoperative outcomes in cardiac surgery

Authors

  • Anantachote Vimuktanandana Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
  • Wirinda Chiravanich Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
  • Pakorn Urusopone Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
  • Pongpol Sirilaksanamanon Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
  • Toonchai Indrambarya Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand

Keywords:

Preoperative cognitive dysfunction, cardiac surgery, postoperative outcome, cognitive assessment

Abstract

Background: Preoperative cognitive dysfunction (PreOCD) has not been well described as a risk factor for poor outcomes in cardiac surgery. This study was aimed to demonstrate the effects of PreOCD on postoperative outcomes in cardiac surgery.

Methods: One hundred adult patients undergoing elective open cardiac surgery at King Chulalongkorn Memorial Hospital were recruited. The Montreal Cognitive Assessment (MoCA) was used to evaluate cognitive function the evening before surgery and defined a score of less than 26 as cognitive impairment. We compared postoperative outcome data between patients with PreOCD group and no PreOCD group.

Results: One patient in the PreOCD group withdrew from our study. Sixty nine out of 99 patients (68.31%) had PreOCD. In the PreOCD group, the postoperative mechanical ventilation period was significantly longer (15.9 gif.latex?\pm 26.6 vs. 7.4 gif.latex?\pm 8.76 hours, P = 0.018), ICU stay was significantly longer (39.9 gif.latex?\pm 43.7 vs. 27.6 gif.latex?\pm 15.0 hours, P = 0.039), and the cost of hospital stay was significantly higher (13,540 gif.latex?\pm 6,355 vs. 11,264 gif.latex?\pm 5,229 baht, P = 0.014). However, the length of hospital stay was not significantly different (10.1 gif.latex?\pm 3.8 vs. 9.3 gif.latex?\pm 4.4 days, P = 0.384).

Conclusions: We demonstrated the adverse effects of PreOCD on patients outcomes after cardiac surgery. Identifying PreOCD may be useful in risk stratification during preoperative assessment to improve surgical outcomes.

Downloads

Download data is not yet available.

References

Newman MF, Kirchner JL, Phillips-Bute B, Gaver V, Grocott H, Jones RH, et al. Longitudinal assessment of neurocognitive function after coronary-artery bypass surgery. N Engl J Med 2001;344:395-402.

https://doi.org/10.1056/NEJM200102083440601

Steinmetz J, Christensen KB, Lund T, Lohse N, Rasmussen LS. Long-term consequences of postoperative cognitive dysfunction. Anesthesiology 2009;110:548-55.

https://doi.org/10.1097/ALN.0b013e318195b569

Aykut K, Albayrak G, Guzeloglu M, Baysak A, Hazan E. Preoperative mild cognitive dysfunction predicts pulmonary complications after coronary artery bypass graft surgery. J Cardiothorac Vasc Anesth 2013;27: 1267-70. https://doi.org/10.1053/j.jvca.2013.01.028

Robinson TN, Wu DS, Pointer LF, Dunn CL, Moss M. Preoperative cognitive dysfunction is related to adverse postoperative outcomes in the elderly. J Am Coll Surg 2012;215:12-7.

https://doi.org/10.1016/j.jamcollsurg.2012.02.007

Vichitvejpaisal P, Preechakoon B, Supaprom W, Sriputtaruk S, Rodpaewpaln S, Saen-Ubol R, et al. The Montreal Cognitive Assessment as a screening tool for preoperative cognitive impairment in geriatric patients. J Med Assoc Thai 2015;98:782-9.

Waite LM, Broe GA, Grayson DA, Creasey H. Preclinical syndromes predict dementia: the Sydney older persons study. J Neurol Neurosurg Psychiatry 2001;71:296-302.

https://doi.org/10.1136/jnnp.71.3.296

McLennan SN, Mathias JL, Brennan LC, Stewart S. Validity of the Montreal Cognitive Assessment (MoCA) as a screening test for Mild Cognitive Impairment (MCI) in a cardiovascular population. J Geriatr Psychiatry Neurol 2011;24:33-8. https://doi.org/10.1177/0891988710390813

Smith T, Gildeh N, Holmes C. The Montreal Cognitive Assessment: validity and utility in a memory clinic setting. Can J Psychiatry 2007;52:329-32. https://doi.org/10.1177/070674370705200508

Bernstein IH, Lacritz L, Barlow CE, Weiner MF, DeFina LF. Psychometric evaluation of the Montrea Cognitive Assessment (MoCA) in three diverse samples. Clin Neuropsychol 2011;25:119-26.

https://doi.org/10.1080/13854046.2010.533196

Torisson G, Minthon L, Stavenow L, Londos E. Cognitive impairment is undetected in medical inpatients: a study of mortality and recognition amongst healthcare professionals. BMC Geriatr 2012;12:47. https://doi.org/10.1186/1471-2318-12-47

Busse A, Bischkopf J, Riedel-Heller SG, Angermeyer MC. Mild cognitive impairment: prevalence and incidence according to different diagnostic criteria. Results of the Leipzig Longitudinal Study of the Aged (LEILA75+). Br J Psychiatry 2003;182:449-54. https://doi.org/10.1192/bjp.182.5.449

Crosby G, Culley DJ, Hyman BT. Preoperative cognitive assessment of the elderly surgical patient: a call for action. Anesthesiology 2011;114:1265-8. https://doi.org/10.1097/ALN.0b013e31821b1bc8

Downloads

Published

2023-08-04

How to Cite

1.
Vimuktanandana A, Chiravanich W, Urusopone P, Sirilaksanamanon P, Indrambarya T. Effect of preoperative cognitive dysfunction on postoperative outcomes in cardiac surgery. Chula Med J [Internet]. 2023 Aug. 4 [cited 2024 Dec. 22];63(1). Available from: https://he05.tci-thaijo.org/index.php/CMJ/article/view/269

Issue

Vol. 63 No. 1 (2019): Chulalongkorn Medical Journal

Section

Original Articles

License

Copyright (c) 2023 Chulalongkorn Medical Journal

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.