ORIGINAL ARTICLE
Preoperative Mild Cognitive Dysfunction Predicts Pulmonary Complications After Coronary Artery Bypass Graft Surgery

https://doi.org/10.1053/j.jvca.2013.01.028Get rights and content

Objectives

In elderly patients with mild cognitive impairment, noncompliance with respiratory exercises, ineffective expectoration, reluctance in mobilization, and difficulty in learning the use of drugs such as inhalers were observed in the early postoperative period after coronary artery bypass graft surgery. It was hypothesized that respiratory complications may be more frequent in these patients, and so the postoperative respiratory complications in patients with preoperative mild cognitive impairment were compared with the postoperative respiratory complications of a control group.

Design

A prospective cohort control.

Setting

A university hospital.

Participants

Patients undergoing elective coronary artery bypass graft surgery.

Interventions

Investigators separated 48 patients>70 years old who were scheduled for elective coronary artery bypass graft surgery into two groups: patients with preoperative mild cognitive impairment (group A, n = 25) and patients with no cognitive impairment (control group; group B, n = 23). The patients’ cognitive status was evaluated preoperatively by the Montreal Cognitive Assessment test.

Measurements and Main Results

Pulmonary functions and respiratory complications were evaluated via chest x-rays and spirometry tests preoperatively and postoperatively. A significant difference was observed between the groups, particularly with regard to atelectasis and prolonged ventilation (p <0.001 and p <0.05). No significant impairment was observed in the spirometry tests of the control group. However, a significant deterioration was observed in the postoperative spirometry tests of patients with preoperative mild cognitive impairment.

Conclusions

This study suggested that mild cognitive impairment was associated with pulmonary complications after coronary artery bypass graft surgery.

Section snippets

Methods

The trial was approved by the institutional research and ethical committee at the authors’ institution. Informed consent was obtained from each patient.

The authors separated 48 patients>70 years old who were scheduled to undergo elective coronary artery bypass graft (CABG) surgery into two groups. Group A (n = 25) comprised patients with preoperative mild cognitive impairment. Group B (n = 23), the control group, consisted of patients with no cognitive impairment.

After premedication, anesthesia

Results

The patient demographics and the risk factors of the study groups were similar (p>0.05) (Table 1). No revision because of bleeding was needed in any of the patients. The preoperative mean MoCA score was 19.25±2.1 in group A and 27.16±1.3 in group B (p = 0.036) (Table 2).

The rate of postoperative atelectasis detected on postoperative day 3 was 84% in the group with preoperative mild cognitive impairment (group A) and 17% in the control group. The difference between the groups was statistically

DIscussIon

Approximately 1 million CABG procedures are performed worldwide every year.9 Postoperative pulmonary complications are the most frequent and significant contributor to morbidity, mortality, and costs associated with hospitalization.10, 11, 12 Every clinician familiar with the postoperative care of patients undergoing cardiac surgery anticipates pulmonary complications.13

Many different factors may cause pulmonary complications after cardiac surgeries. Preoperative risk factors include chronic

Conclusions

Mild cognitive impairment is associated with pulmonary complications after CABG. Atelectasis was the most commonly detected complication in patients with cognitive impairment in the preoperative period.

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