Report of the Substudy Assessing the Impact of Neurocognitive Function on Quality of Life 5 Years After Cardiac Surgery

Abstract

Background and Purpose-The importance of perioperative cognitive decline has long been debated. We recently demonstrated a significant correlation between perioperative cognitive decline and long-term cognitive dysfunction. Despite this association, some still question the importance of these changes in cognitive function to the quality of life of patients and their families. The purpose of our investigation was to determine the association between cognitive dysfunction and long-term quality of life after cardiac surgery. Methods-After institutional review board approval and patient informed consent, 261 patients undergoing cardiac surgery with cardiopulmonary bypass were enrolled and followed for 5 years. Cognitive function was measured with a battery of tests at baseline, discharge, and 6 weeks and 5 years postoperatively. Quality of life was assessed with well-validated, standardized assessments at the 5-year end point. Results-Our results demonstrate significant correlations between cognitive function and quality of life in patients after cardiac surgery. Lower 5-year overall cognitive function scores were associated with lower general health and a less productive working status. Multivariable logistic and linear regression controlling for age, sex, education, and diabetes confirmed this strong association in the majority of areas of quality of life. Conclusions-Five

Quality of life in chronic disease patients

“…35 While, neurocognitive functioning 5 years after coronary artery bypass grafting (CABG), is found to have a strong connection with decreased HRQoL. 36 There are a number of papers that study HRQoL in stroke. Their findings suggest that factors such as hemispheral localization of the lesion, paresis, coordination disturbances and especially subjective tendency to depression are highly correlated with poor HRQoL.…”

Early benefit of preserved cognitive function is not sustained at one-year after cardiac surgery: a longitudinal follow-up of the randomized controlled trial

“…18,24 Similarly to noncardiac surgery, it has been shown that patients with POCD had poorer quality of life when assessed at one year and five years after otherwise successful cardiac surgery. 25,26 Lower five-year overall cognitive function scores were associated with lower general health and a less productive working status. These findings have significant social and financial implications.…”

Effect of intravenous lidocaine on the transcerebral inflammatory response during cardiac surgery: a randomized-controlled trial

“…3,4 The mechanism(s) of POCD remains elusive, although several contributing factors have been proposed, 1 including the exacerbation of preoperative cognitive impairment, 5 genetic predisposition, cerebral embolism/hypoperfusion, hemodilution, hyperglycemia, anesthetic neurotoxicity, [6][7][8] and perioperative hyperthermia. 9 In addition to these mechanisms, cerebral inflammation in response to embolic and other events during CPB, manifested by transcerebral platelet activation, 10 has also been proposed as a mechanism linking POCD to cardiac surgery.…”