Postoperative cerebral dysfunction: potential risk factors

Abstract

Over the past few years, a significant amount of clinical data have been obtained in international and Russian medicine,indicating that patients of the older age group with established cardiovascular diseases (CVD) and overweight, sometimes even with mild obesity, apparently have a more favorable clinical prognosis of short- and long-term survival in comparison with patients who have normal body mass index (BMI). This phenomenon has been described as the «obesity paradox», but the existence of this phenomenon remains a subject of controversy. Based on the National Medical Research Center for High Medical Technologies — A. A. Vishnevsky Central Military Clinical Hospital of the Ministry of Defense of the Russian Federation (Krasnogorsk), a singlecenter prospective study was conducted. The study involved 117 patients who underwent carotid endarterectomy (CEA) after a comprehensive examination. In our article, we presented the research data on the effect of the BMI factor on the risk of postoperative cerebral dysfunction (PCD) in CEA and summarized the results of recent studies concerning this phenomenon in patients with CVD. Taking into account the data of the conducted study and world research, it is possible to make several important conclusions. Firstly, normal BMI in older patients with established CVD and planned surgery, mainly on the cardiovascular system, may be a potential risk factor for postoperative complications. Secondly, in this cohort of patients, it may be necessary to revise the reference BMI range in order to prevent the development of PCD and form a clear algorithm for preoperative preparation, including the correction of risk factors.