Abstract
ContextStress response induced by surgery is proposed to play an important role in the pathogenesis of postoperative cognitive dysfunction.ObjectiveTo investigate the association between postoperative serum cortisol level and occurrence of cognitive dysfunction early after coronary artery bypass graft surgery.DesignProspective cohort study.SettingTwo teaching hospitals.PatientsOne hundred and sixth-six adult patients who were referred to elective coronary artery bypass graft surgery from March 2008 to December 2009.InterventionNone.Main Outcome MeasuresNeuropsychological tests were completed one day before and seven days after surgery. Cognitive dysfunction was defined using the same definition as used in the ISPOCD1-study. Blood samples were obtained in the first postoperative morning for measurement of serum cortisol concentration. Multivariate Logistic regression analyses were performed to assess the relationship between serum cortisol level and occurrence of postoperative cognitive dysfunction.ResultsCognitive dysfunction occurred in 39.8% (66 of 166) of patients seven days after surgery. Multivariate Logistic regression analysis showed that high serum cortisol level was significantly associated with the occurrence of postoperative cognitive dysfunction (odds ratio [OR] 2.603, 95% confidence interval [CI] 1.371-4.944, P = 0.003). Other independent predictors of early postoperative cognitive dysfunction included high preoperative New York Heart Association functional class (OR 0.402, 95% CI 0.207-0.782, P = 0.007), poor preoperative Grooved Pegboard test score of nondominant hand (OR 1.022, 95% CI 1.003-1.040, P = 0.020), use of penehyclidine as premedication (OR 2.565, 95% CI 1.109-5.933, P = 0.028), and occurrence of complications within seven days after surgery (OR 2.677, 95% CI 1.201-5.963, P = 0.016).ConclusionsHigh serum cortisol level in the first postoperative morning was associated with increased risk of cognitive dysfunction seven days after coronary artery bypass graft surgery.
Highlights
Cognitive dysfunction is a common central nervous system complication in patients after cardiac surgery
These results suggest that the stress response induced by surgical stimuli might play an important role in the pathogenesis of postoperative cognitive dysfunction (POCD)
We found that high serum cortisol level in the first postoperative morning was associated with increased risk of cognitive dysfunction seven days after surgery
Summary
Cognitive dysfunction is a common central nervous system complication in patients after cardiac surgery It refers to a subtle disorder of thought processes and may influence isolated domains of cognition such as verbal memory, visual memory, language comprehension, attention, or concentration. Extensive clinical studies found that POCD mainly occurred after major complicated surgery (including cardiac and non-cardiac surgery) [3,4,6], but is rarely seen after minor ambulatory surgery [7].
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