M. E. Stanley1, A. Ehsan1, N. Sodha1, F. Sellke1 1Brown University School Of Medicine, Cardiothoracic Surgery, Providence, RI, USA
Introduction: Neurocognitive decline (NCD) is a common complication after cardiac surgery with implications for outcomes and quality of life. Identifying risk factors can help surgeons implement preventative measures, optimize modifiable risk factors, and counsel patients about risk and prognosis.
Methods: Prospective cohort study at a single academic center. 73 patients planned to undergo cardiac surgery (coronary artery bypass grafting, aortic valve replacement, mitral valve replacement, or a combination) were enrolled. The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) was used to measure neurocognitive function preoperatively and on postoperative day four. NCD is defined as a change in RBANS scaled score of < -8 from baseline to POD4. Scores are able to be scaled against normative data based on patient age published by the manufacturer. Patient charts reviewed for medication use within multiple classes: beta-blockers, angiotensin-converting enzyme/angiotensin receptor blockers, calcium channel blockers, statins, oral hypoglycemic agents, and psychotropic medications. Opioid use within first four postoperative days converted to morphine milliequivalents. Categorical variables compared using Fisher’s exact test. Continuous variables compared with unpaired t-test with Welch's correction. Simple linear regression used to evaluate relationship between two continuous variable.
Results: 54 patients underwent the planned operation and completed neurocognitive testing pre-operatively and on postoperative day four. 2 patients withdrew, 4 did not have the planned surgery, and 3 did not complete postoperative testing due to medical condition. NCD was detected in 23 patients (42.6%). Incidence of NCD was significantly higher in patients taking a psychotropic medication (65.2%) than patients not (25.8%), p <0.01. Additionally the change in RBANS score was significantly greater in patients taking a psychotropic medication (M = -12.70, SD = 12.5) compared to patients not (M = -2.90, SD = 7.3), p <0.01. There was no relationship between historical use of beta-blocker, calcium-channel blocker, statin, or oral hypoglycemic medications and incidence of NCD. The incidence of NCD was higher in patients taking an angiotensin-converting enzyme or angiotensin receptor blocker (53.2% vs 27.3%), however did not reach statistical significance (p = 0.09). There was no difference in average opioid use between patients with NCD and those without. Simple linear regression showed no relationship between change in RBANS total scaled score and opioid usage.
Conclusion: Patients with a history of taking psychotropic medications prior to cardiac surgery have an increased risk of acute postoperative neurocognitive decline.
