Abstract
Cardiac surgery and subsequent treatment in the intensive care unit (ICU) has been shown to be associated with functional decline, especially in elderly patients. Due to the different assessment tools and assessment periods, it remains yet unclear what parameters determine unfavorable outcomes. This study sought to identify risk factors during the entire perioperative period and focused on the decline in activity of daily living (ADL) half a year after cardiac surgery. Follow-ups of 125 patients were available. It was found that in the majority of patients (60%), the mean ADL declined by 4.9 points (95% CI, −6.4 to −3.5; p < 0.000). In the “No decline” -group, the ADL rose by 3.3 points (2.0 to 4.6; p < 0.001). A multiple regression analysis revealed that preoperative cognitive impairment (MMSE ≤ 26; Exp(B) 2.862 (95%CI, 1.192–6.872); p = 0.019) and duration of postoperative delirium ≥ 2 days (Exp(B) 3.534 (1.094–11.411); p = 0.035) was independently associated with ADL decline half a year after the operation and ICU. Of note, preoperative ADL per se was neither associated with baseline cognitive function nor a risk factor for functional decline. We conclude that the preoperative assessment of cognitive function, rather than functional assessments, should be part of risk stratification when planning complex cardiosurgical procedures.
Highlights
Cardiac surgery and subsequent intensive care unit (ICU) treatment in patients at higher age have been shown to be associated with sustained cognitive impairment [1,2], being strongly correlated with the perceived quality of life [3]
For 37 patients, the postoperative activity of daily living (ADL) was not completed due to multiple reasons, 14 patients or their relatives declined to participate, and two patients were lost to follow-up, leaving 125 datasets for the analysis of decline in ADL
ADL could not documented before surgery, and two more patients’ relatives declined to complete the ADL questionnaire after surgery, but they all stated that the patients were “doing much worse” than before surgery
Summary
Cardiac surgery and subsequent intensive care unit (ICU) treatment in patients at higher age have been shown to be associated with sustained cognitive impairment [1,2], being strongly correlated with the perceived quality of life [3]. Functional declines—apart from cognitive changes—upon cardiac surgery have been described [4,5]. Another group found an initial functional decrease for four to six weeks, but no differences six months after cardiac surgery [6]. The risk factors for functional decline have been reported to be—among others—impaired preoperative cognitive performance and postoperative delirium [2,4]. Delirium is prevalent in cardiac surgery if extracorporeal circulation is required, as it provokes a non-infectious systemic inflammatory syndrome (SIRS) [9]
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