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a Department of Cardiac Surgery, Morristown Memorial and Gagnon Heart Hospital, Atlantic Health, Morristown, New Jersey
b Department of Cardiac Research, Morristown Memorial and Gagnon Heart Hospital, Atlantic Health, Morristown, New Jersey
c Department of Psychiatry, Morristown Memorial and Gagnon Heart Hospital, Atlantic Health, Morristown, New Jersey
d Office of Grants and Research, Biostatistics, Atlantic Health, Morristown, New Jersey
e Neuropsychology, Morris Psychological Group, Parsippany, New Jersey
Accepted for publication August 29, 2008.
* Address correspondence to Dr Slater, Mid-Atlantic Surgical Associates, 95 Madison Avenue, Morristown, NJ 07962 (Email: james.slater{at}atlantichealth.org).
Presented at the Forty-third Annual Meeting of The Society of Thoracic Surgeons, San Diego, CA, Jan 29–31, 2007.
Background: Previous studies have reported an 11% to 75% incidence of postoperative cognitive decline among cardiac surgery patients. The INVOS Cerebral Oximeter (Somanetics Corp, Troy, MI) is a Food and Drug Administration approved device that measures regional cerebral oxygen (rSO 2) saturation. The purpose of this study is to examine whether decreased rSO 2 predicts cognitive decline and prolonged hospital stay after coronary artery bypass grafting (CABG).
Methods: The rSO 2 was monitored intraoperatively in a cohort of primary CABG patients. Patients were prospectively randomized to a blinded control group or an unblinded intervention group. Cognitive function was assessed preoperatively, postoperatively, and at 3 months using a battery of standardized neurocognitive tests. Cognitive decline was defined as a decrease of one standard deviation or more in performance on at least one neurocognitive measure. The rSO 2 desaturation score was calculated by multiplying rSO 2 below 50% by time (seconds). Multivariate logistic regression models were used to assess cognitive decline and hospital stay. The change in cognitive performance was also assessed using a multivariate linear regression model.
Results: Patients with rSO 2 desaturation score greater than 3,000%-second had a significantly higher risk of early postoperative cognitive decline [p = 0.024]. Patients with rSO 2 desaturation score greater than 3,000%-second also had a near threefold increased risk of prolonged hospital stay (>6 days) [p = 0.007].
Conclusions: Intraoperative cerebral oxygen desaturation is significantly associated with an increased risk of cognitive decline and prolonged hospital stay after CABG.
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