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Ann Thorac Surg 2004;77:597-603
© 2004 The Society of Thoracic Surgeons
a Denver Veterans Affairs Medical Center, Denver, Colorado, USA
b Department of Medicine, University of Colorado Health Sciences Center, Denver, Colorado, USA
c Department of Surgery, University of Colorado Health Sciences Center, Denver, Colorado, USA
d Department of Neuropsychiatry, University of Colorado Health Sciences Center, Denver, Colorado, USA
e Department of Preventive Medicine and Biometrics, and the Colorado Health Outcomes Program, University of Colorado Health Sciences Center, Denver, Colorado, USA
f The Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
g Department of Veteran Affairs Central Office, Washington, DC, USA
h Veterans Affairs Cooperative Studies Program Coordinating Center, Hines VAMC, Hines, Illinois, USA
i Cardiothoracic Surgery, Tucson VAMC, USA
j Department of Surgery, University of Arizona, Tucson, Arizona, USA
k Anesthesia Service, San Francisco VAMC, USA
l Department of Anesthesia and Perioperative Care, University of California, San Francisco, San Francisco, California, USA
Accepted for publication July 17, 2003.
* Address reprint requests to Dr Ho, 1055 Clermont St (111B), Denver, CO 80220, USA.
e-mail: michael.ho{at}uchsc.edu
BACKGROUND: A significant number of patients develop cognitive impairment that persists for months following coronary artery bypass grafting (CABG) surgery. Our objectives were to identify patient-related risk factors, processes of care, and the occurrence of any perioperative complications associated with cognitive decline.
METHODS: Nine hundred thirty-nine patients enrolled in the Processes, Structures, and Outcomes of Care in Cardiac Surgery study undergoing CABG-only surgery at 14 Veterans Administration medical centers between 1992 and 1996 completed a short battery of cognitive tests at baseline and 6-months post-CABG. The composite cognitive score was based on the sum of errors for each individual item in the battery. Multiple linear regression analyses were used to identify independent predictors of the 6-month composite cognitive score.
RESULTS: In multivariable analyses, patient characteristics associated with cognitive decline included cerebrovascular disease (p = 0.009), peripheral vascular disease (p = 0.007), history of chronic disabling neurologic illness (p = 0.016), and living alone (p = 0.049), while the number of years of education (p = 0.001) was inversely related to cognitive decline. After adjustment for baseline patient risk factors, the presence of any postoperative complication(s) (p = 0.001) was also associated with cognitive decline while cardiopulmonary bypass time (p = 0.008) was inversely related to cognitive decline.
CONCLUSIONS: Patients with noncoronary manifestations of atherosclerosis, chronic disabling neurologic illness, or limited social support are at risk for cognitive decline after CABG surgery. In contrast, more years of education were associated with less cognitive decline. Preoperative assessment of risk factors identified in this study may be useful when counseling patients about the risk for cognitive decline following CABG surgery.
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