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Ann Thorac Surg 2007;83:370-373
© 2007 The Society of Thoracic Surgeons

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Editorials

Why Serial Assessments of Cardiac Surgery Patients’ Neurobehavioral Performances are Misleading

^a Memory Assessment and Research Services, University of North Carolina Wilmington, Wilmington, North Carolina
^b Department of Psychology, University of North Carolina Wilmington, Wilmington, North Carolina

^_* Address correspondence to Dr Keith, Department of Psychology, University of North Carolina, Wilmington, 601 South College Rd, Wilmington, NC 28403-5612 (Email: keithj@uncw.edu).

The first 300 words of the full text of this article appear below.

In 1995, a statement of consensus was published in The Annals of Thoracic Surgery recommending that researchers who assess neurobehavioral outcomes after cardiac surgery adopt a standard set of core procedures [1]. The purpose of the present editorial is to evaluate statement 3 of the Statement of Consensus that reads: "The individual change in performance from baseline to a time after operation is essential to any evaluation of the impact of the operation or any intervention associated with it" [1].

We vigorously endorse standardized and rigorous neuropsychological methods and commend the efforts of the researchers and clinicians who contributed to the Statement of Consensus. Nevertheless the soundness of each statement of the Statement of Consensus rests on the validity of the assumptions from which they are derived. Presently our focus is on the validity of the assumptions underlying statement 3.

Blumenthal alluded to the assumptions underlying statement 3 in the published commentary that accompanied the Statement of Consensus when he noted, "part of the rationale for statement 3 is to address the issue that these patients may be abnormal preoperatively. Therefore it is important to examine change in scores from baseline" [1]. Thus statement 3 assumes that (1) patients’ neurobehavioral performances may be abnormal preoperatively, (2) preoperative neurobehavioral performances are valid measures of neurobehavioral competence, and (3) one can use differences between measures obtained preoperatively versus postoperatively to isolate an effect of surgery or treatment, or both, on neurobehavioral fitness. The validity of assumption 1 that patients’ neurobehavioral performances may be abnormal preoperatively is convincingly demonstrated in the published literature [2]. However a considerable body of evidence runs counter to the second and third assumptions. As follows we examine assumptions 2 and 3 and consider the impact of the violations of . . . [Full Text of this Article]

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