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Stanley ME, Ehsan A, Sodha NR, Sellke FW. History of Psychoactive Medication a Risk Factor for Neurocognitive Decline After Cardiac Surgery. J Surg Res 2024; 295:414-422. [PMID: 38070255 PMCID: PMC10922466 DOI: 10.1016/j.jss.2023.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 09/24/2023] [Accepted: 11/08/2023] [Indexed: 12/29/2023]
Abstract
INTRODUCTION Neurocognitive decline (NCD) is a common complication after cardiac surgery with implications for outcomes and quality of life. Identifying risk factors can help surgeons implement preventative measures, optimize modifiable risk factors, and counsel patients about risk and prognosis. METHODS Prospective cohort study at a single academic center. 104 patients planned to undergo cardiac surgery were enrolled. The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) was used to measure neurocognitive function preoperatively, on postoperative day four, and postoperative day 30. NCD is defined as a change in RBANS scaled score of < -8 from baseline to postoperative day 4. Patient charts were reviewed for medication history: beta-blockers, angiotensin-converting enzyme and angiotensin receptor blockers, calcium channel blockers, statins, oral hypoglycemic agents, and psychoactive medications. Charts were also reviewed to calculate postoperative opioid usage. RESULTS NCD was detected in 42.9% of patients. Incidence of NCD was significantly higher in patients taking a psychoactive medication (56.8%) than patients not (31.9%), P < 0.03. There was no relationship between historical use of beta-blocker, calcium-channel blocker, statin, or oral hypoglycemic medications and incidence of NCD. Simple linear regression showed no relationship between change in RBANS total scaled score and opioid usage. There was no difference in incidence of NCD at 1 mo. CONCLUSIONS Patients with a history of taking psychoactive medications prior to cardiac surgery have an increased risk of acute postoperative NCD.
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Affiliation(s)
- Madigan E Stanley
- Divison of Cardiothoracic Surgery, Warren Alpert Medical School at Brown University and Rhode Island Hospital, Providence, Rhode Island.
| | - Afshin Ehsan
- Divison of Cardiothoracic Surgery, Warren Alpert Medical School at Brown University and Rhode Island Hospital, Providence, Rhode Island
| | - Neel R Sodha
- Divison of Cardiothoracic Surgery, Warren Alpert Medical School at Brown University and Rhode Island Hospital, Providence, Rhode Island
| | - Frank W Sellke
- Divison of Cardiothoracic Surgery, Warren Alpert Medical School at Brown University and Rhode Island Hospital, Providence, Rhode Island
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Stanley ME, Kant S, Raker C, Sabe S, Sodha NR, Ehsan A, Sellke FW. Effect of Patient Sex on Neurocognitive Decline after Cardiac Surgery. J Am Coll Surg 2023; 236:1112-1124. [PMID: 36727930 DOI: 10.1097/xcs.0000000000000574] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Neurocognitive decline (NCD) is a common complication of cardiac surgery. Understanding risk factors helps surgeons counsel patients pre- and perioperatively about risk, prevention, and treatment. STUDY DESIGN Patients undergoing cardiac surgery using cardiopulmonary bypass underwent pre- and postoperative neurocognitive testing. Neurocognitive data are presented as a change from baseline to either postoperative day 4 or to 1 month. The score is standardized with respect to age. RESULTS Eighty-four patients underwent surgery and completed postoperative neurocognitive testing. There was no significant difference in baseline neurocognitive function. NCD was more common in female patients (71%) than male patients (26.4%) on postoperative day 4. By 1 month, the incidence of NCD is similar between female (15.0%) and male patients (14.3%). Of note, female patients differed from male patients in preoperative hematocrit, preoperative creatinine, and type of surgery. CONCLUSIONS In the acute postoperative period, female patients are both more likely to experience NCD and experience a more severe change from baseline cognitive function. This difference between male and female patients resolves by the 1 month follow-up point. Female patients had a lower preoperative hematocrit and were more likely to receive intraoperative and perioperative blood transfusion. Lower preoperative hematocrit appears to mediate the difference in NCD between male and female patients.
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Affiliation(s)
- Madigan E Stanley
- From the Division of Cardiothoracic Surgery, Warren Alpert Medical School at Brown University and Rhode Island Hospital, Providence, RI (Stanley, Sabe, Sodha, Ehsan, Sellke)
| | - Shawn Kant
- the Warren Alpert Medical School at Brown University, Providence, RI (Kant)
| | - Christina Raker
- Lifespan Biostatistics, Epidemiology, and Research Design Core, Providence, RI (Raker)
| | - Sharif Sabe
- From the Division of Cardiothoracic Surgery, Warren Alpert Medical School at Brown University and Rhode Island Hospital, Providence, RI (Stanley, Sabe, Sodha, Ehsan, Sellke)
| | - Neel R Sodha
- From the Division of Cardiothoracic Surgery, Warren Alpert Medical School at Brown University and Rhode Island Hospital, Providence, RI (Stanley, Sabe, Sodha, Ehsan, Sellke)
| | - Afshin Ehsan
- From the Division of Cardiothoracic Surgery, Warren Alpert Medical School at Brown University and Rhode Island Hospital, Providence, RI (Stanley, Sabe, Sodha, Ehsan, Sellke)
| | - Frank W Sellke
- From the Division of Cardiothoracic Surgery, Warren Alpert Medical School at Brown University and Rhode Island Hospital, Providence, RI (Stanley, Sabe, Sodha, Ehsan, Sellke)
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Liu Y, Li L, Hu H, Yang J, Zhang X, Chen L, Chen F, Hao S, Li W, Huang G. Association between preoperative hematocrit and postoperative 30-day mortality in adult patients with tumor craniotomy. Front Neurol 2023; 14:1059401. [PMID: 36895901 PMCID: PMC9990837 DOI: 10.3389/fneur.2023.1059401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 02/01/2023] [Indexed: 02/23/2023] Open
Abstract
Background The purpose of this research was to synthesize the American College of Surgeons National Surgical Quality Improvement Program database to investigate the link between preoperative hematocrit and postoperative 30-day mortality in patients with tumor craniotomy. Methods A secondary retrospective analysis of electronic medical records of 18,642 patients with tumor craniotomy between 2012 and 2015 was performed. The principal exposure was preoperative hematocrit. The outcome measure was postoperative 30-day mortality. We used the binary logistic regression model to explore the link between them and conducted a generalized additive model and smooth curve fitting to investigate the link and its explicit curve shape. We conducted sensitivity analyses by converting a continuous HCT into a categorical variable and calculated an E-value. Results A total of 18,202 patients (47.37% male participants) were included in our analysis. The postoperative 30-day mortality was 2.5% (455/18,202). After adjusting for covariates, we found that preoperative hematocrit was positively associated with postoperative 30-day mortality (OR = 0.945, 95% CI: 0.928, 0.963). A non-linear relationship was also discovered between them, with an inflection point at a hematocrit of 41.6. The effect sizes (OR) on the left and right sides of the inflection point were 0.918 (0.897, 0.939) and 1.045 (0.993, 1.099), respectively. The sensitivity analysis proved that our findings were robust. The subgroup analysis demonstrated that a weaker association between preoperative hematocrit and postoperative 30-day mortality was found for patients who did not use steroids for chronic conditions (OR = 0.963, 95% CI: 0.941-0.986), and a stronger association was discovered in participants who used steroids (OR = 0.914, 95% CI: 0.883-0.946). In addition, there were 3,841 (21.1%) cases in the anemic group (anemia is defined as a hematocrit (HCT) <36% in female participants and <39% in male participants). In the fully adjusted model, compared with the non-anemic group, patients in the anemic group had a 57.6% increased risk of postoperative 30-day mortality (OR = 1.576; 95% CI: 1.266, 1.961). Conclusion This study confirms that a positive and nonlinear association exists between preoperative hematocrit and postoperative 30-day mortality in adult patients undergoing tumor craniotomy. Preoperative hematocrit was significantly associated with postoperative 30-day mortality when the preoperative hematocrit was <41.6.
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Affiliation(s)
- Yufei Liu
- Shenzhen Key Laboratory of Neurosurgery, Department of Neurosurgery, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China.,Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Shenzhen University Health Science Center, Shenzhen, Guangdong, China
| | - Lunzou Li
- Department of Neurosurgery, Hechi People's Hospital, Hechi, Guangxi, China
| | - Haofei Hu
- Shenzhen University Health Science Center, Shenzhen, Guangdong, China.,Department of Nephrology, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, China
| | - Jihu Yang
- Shenzhen Key Laboratory of Neurosurgery, Department of Neurosurgery, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China.,Shenzhen University Health Science Center, Shenzhen, Guangdong, China
| | - Xiejun Zhang
- Shenzhen Key Laboratory of Neurosurgery, Department of Neurosurgery, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China.,Shenzhen University Health Science Center, Shenzhen, Guangdong, China
| | - Lei Chen
- Shenzhen Key Laboratory of Neurosurgery, Department of Neurosurgery, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China.,Shenzhen University Health Science Center, Shenzhen, Guangdong, China
| | - Fanfan Chen
- Shenzhen Key Laboratory of Neurosurgery, Department of Neurosurgery, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China.,Shenzhen University Health Science Center, Shenzhen, Guangdong, China
| | - Shuyu Hao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Weiping Li
- Shenzhen Key Laboratory of Neurosurgery, Department of Neurosurgery, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China.,Shenzhen University Health Science Center, Shenzhen, Guangdong, China
| | - Guodong Huang
- Shenzhen Key Laboratory of Neurosurgery, Department of Neurosurgery, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China.,Shenzhen University Health Science Center, Shenzhen, Guangdong, China
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Stanley ME, Sellke FW. Neurocognitive decline in cardiac surgery patients: what do we know? J Thorac Cardiovasc Surg 2022:S0022-5223(22)00825-X. [DOI: 10.1016/j.jtcvs.2022.07.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 07/15/2022] [Accepted: 07/28/2022] [Indexed: 10/16/2022]
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Scrimgeour LA, Ikeda I, Sellke NC, Shi G, Feng J, Cizginer S, Ehsan A, Sodha NR, Sellke FW. Glycemic control is not associated with neurocognitive decline after cardiac surgery. J Card Surg 2022; 37:138-147. [PMID: 34713498 PMCID: PMC8752128 DOI: 10.1111/jocs.16102] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 08/14/2021] [Accepted: 09/22/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Whether perioperative glycemic control is associated with neurocognitive decline (NCD) after cardiac surgery was examined. METHODS Thirty patients undergoing cardiac surgery utilizing cardiopulmonary bypass (CPB) were screened for NCD preoperatively and on postoperative day 4 (POD4). Indices of glucose control were examined. Serum cytokine levels were measured and human transcriptome analysis was performed on blood samples. Neurocognitive data are presented as a change from baseline to POD4 in a score standardized with respect to age and gender. RESULTS A decline in neurocognitive function was identified in 73% (22/30) of patients on POD4. There was no difference in neurocognitive function between patients with elevated HbA1c levels preoperatively (p = .973) or elevated fasting blood glucose levels the morning of surgery (>126 mg/dl, p = .910), or a higher maximum blood glucose levels during CPB (>180 mg/dl, p = .252), or higher average glucose levels during CPB (>160 mg/dl, p = .639). Patients with postoperative leukocytosis (WBC ≥ 10.5) had more NCD when compared to their baseline function (p = .03). Patients with elevated IL-8 levels at 6 h postoperatively had a significant decline in NCD at POD4 (p = .04). Human transcriptome analysis demonstrated unique and differential patterns of gene expression in patients depending on the presence of DM and NCD. CONCLUSIONS Perioperative glycemic control does not have an effect on NCD soon after cardiac surgery. The profile of gene expression was altered in patients with NCD with or without diabetes.
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Affiliation(s)
- Laura A. Scrimgeour
- Division of Cardiothoracic Surgery, Department of Surgery, Lifespan Hospitals, Warren Alpert School of Medicine of Brown University, Providence, RI
| | - Ian Ikeda
- Division of Cardiothoracic Surgery, Department of Surgery, Lifespan Hospitals, Warren Alpert School of Medicine of Brown University, Providence, RI
| | - Nicholas C. Sellke
- Division of Cardiothoracic Surgery, Department of Surgery, Lifespan Hospitals, Warren Alpert School of Medicine of Brown University, Providence, RI
| | - Guangbin Shi
- Division of Cardiothoracic Surgery, Department of Surgery, Lifespan Hospitals, Warren Alpert School of Medicine of Brown University, Providence, RI
| | - Jun Feng
- Division of Cardiothoracic Surgery, Department of Surgery, Lifespan Hospitals, Warren Alpert School of Medicine of Brown University, Providence, RI
| | - Sevdenur Cizginer
- Division of Geriatrics and Palliative Care, Lifespan Hospitals, Warren Alpert School of Medicine of Brown University, Providence, RI
| | - Afshin Ehsan
- Division of Cardiothoracic Surgery, Department of Surgery, Lifespan Hospitals, Warren Alpert School of Medicine of Brown University, Providence, RI
| | - Neel R. Sodha
- Division of Cardiothoracic Surgery, Department of Surgery, Lifespan Hospitals, Warren Alpert School of Medicine of Brown University, Providence, RI
| | - Frank W. Sellke
- Division of Cardiothoracic Surgery, Department of Surgery, Lifespan Hospitals, Warren Alpert School of Medicine of Brown University, Providence, RI
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Zhang X, Fu Q. [Correlation of cerebrospinal fluid amyloid β-protein 42 and neurofilament light protein levels with postoperative neurocognitive dysfunction in elderly patients]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2021; 41:574-578. [PMID: 33963718 DOI: 10.12122/j.issn.1673-4254.2021.04.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To detect cerebrospinal fluid levels of amyloid beta- protein 42 (Aβ42) and neurofilament light protein (NFL) and explore their correlation with postoperative neurocognitive dysfunction (PNCD) in elderly patients. OBJECTIVE A total of 90 elderly patients undergoing hip or knee replacement with joint epidural anesthesia in our Hospital between January, 2017 and December, 2018 were recruited in this study. The levels of Aβ42 and NFL in the cerebrospinal fluid were detected using ELISA. Simple cognitive status assessment scale (MMSE) was used to evaluate the cognitive status of the patients 1 day before and 7 days after the surgery. All the patients underwent neurocognitive function tests, and the z-score method was used to determine the occurrence of PNCD. Spearman rank correlation analysis was used to analyze the correlation of Aβ42 and NFL levels in the cerebrospinal fluid with MMSE scores. Receiver operating characteristic curve (ROC) was used to analyze the predictive value of cerebrospinal fluid Aβ42 and NFL levels for PNCD. OBJECTIVE PNCD occurred in 38 of the 90 elderly patients, with an incidence of 42.2%. The level of Aβ42 in the cerebrospinal fluid was significantly lower in PNCD group than in the nonPNCD group (1.96 vs 2.54 ng/mL; t=3.29, P < 0.05); the concentration of NFL in the cerebrospinal fluid was significantly higher in PNCD group than in non- PNCD group (4.59 vs 3.16 ng/mL; t=3.72, P < 0.05). Aβ42 level in the cerebrospinal fluid was positively correlated while NFL was negatively correlated with the MMSE score of the patients (r=-0.659, P < 0.05; r=-0.626, P < 0.05). ROC curve analysis showed that the area under the curve (AUC) of cerebrospinal fluid Aβ42 and NFL levels were 0.744 and 0.768, respectively; the AUC of their combination was 0.847 for prediction of PNCD. OBJECTIVE Elderly patients with PNCD have significantly higher levels of Aβ42 and NFL in the cerebrospinal fluid than those without PNCD. Both Aβ42 and NFL levels in the cerebrospinal fluid can help to predict the occurrence of POCD in elderly patients, and their combination has a higher diagnostic value.
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Affiliation(s)
- X Zhang
- Department of Anesthesiology, General Hospital of PLA, Beijing 100853, China
| | - Q Fu
- Department of Anesthesiology, General Hospital of PLA, Beijing 100853, China
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Glumac S, Kardum G, Sodic L, Bulat C, Covic I, Carev M, Karanovic N. Longitudinal assessment of preoperative dexamethasone administration on cognitive function after cardiac surgery: a 4-year follow-up of a randomized controlled trial. BMC Anesthesiol 2021; 21:129. [PMID: 33892653 PMCID: PMC8063389 DOI: 10.1186/s12871-021-01348-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Accepted: 04/16/2021] [Indexed: 01/13/2023] Open
Abstract
Background The pathogenesis of postoperative cognitive decline (POCD) is still poorly understood; however, the inflammatory response to surgical procedures seems likely to be involved. In addition, our recent randomized controlled trial showed that perioperative corticosteroid treatment may ameliorate early POCD after cardiac surgery. To assess the long-term effect of dexamethasone administration on cognitive function, we conducted a 4-year follow-up. Methods The patients were randomized to receive a single intravenous bolus of 0.1 mg kg− 1 dexamethasone or placebo 10 h before elective cardiac surgery. The endpoint in both groups was POCD incidence on the 6th day and four years postoperatively. Results Of the 161 patients analyzed previously, the current follow-up included 116 patients. Compared to the 62 patients in the placebo group, the 54 patients in the dexamethasone group showed a lower incidence of POCD on the 6th day (relative risk (RR), 0.510; 95 % confidence interval (CI), 0.241 to 1.079; p = 0.067, time interval also analyzed previously) and four years (RR, 0.459; 95 % CI, 0.192 to 1.100; p = 0.068) after cardiac surgery. The change in cognitive status between the two postoperative measurements was not significant (p = 0.010) among the patients in the dexamethasone group, in contrast to patients in the placebo group (p = 0.673). Conclusions Although statistical significance was not reached in the current study, the prophylactic administration of dexamethasone seems to be useful to prevent POCD development following cardiac surgery. However, further large multicenter research is needed to confirm these directions. Trial registration ClinicalTrials.gov identifier: NCT02767713 (10/05/2016). Supplementary Information The online version contains supplementary material available at 10.1186/s12871-021-01348-z.
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Affiliation(s)
- Sandro Glumac
- Department of Anesthesiology and Intensive Care, University Hospital of Split, Spinciceva 1, 21000, Split, Croatia.
| | - Goran Kardum
- Department of Psychology, Faculty of Humanities and Social Sciences, University of Split, Split, Croatia
| | - Lidija Sodic
- Department of Neurology, University Hospital of Split, Split, Croatia
| | - Cristijan Bulat
- Department of Cardiac Surgery, University Hospital of Split, Split, Croatia
| | - Ivan Covic
- School of Medicine, University of Split, Split, Croatia
| | - Mladen Carev
- Department of Anesthesiology and Intensive Care, University Hospital of Split, Spinciceva 1, 21000, Split, Croatia.,Department of Anesthesiology and Intensive Medicine, School of Medicine, University of Split, Split, Croatia
| | - Nenad Karanovic
- Department of Anesthesiology and Intensive Care, University Hospital of Split, Spinciceva 1, 21000, Split, Croatia.,Department of Anesthesiology and Intensive Medicine, School of Medicine, University of Split, Split, Croatia
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