Predictors of cognitive decline following coronary artery bypass graft surgery.
BACKGROUND
A significant number of patients develop cognitive impairment that persists for months following coronary artery bypass grafting (CABG) surgery. Our objectives were to identify patient-related risk factors, processes of care, and the occurrence of any perioperative complications associated with cognitive decline.


METHODS
Nine hundred thirty-nine patients enrolled in the Processes, Structures, and Outcomes of Care in Cardiac Surgery study undergoing CABG-only surgery at 14 Veterans Administration medical centers between 1992 and 1996 completed a short battery of cognitive tests at baseline and 6-months post-CABG. The composite cognitive score was based on the sum of errors for each individual item in the battery. Multiple linear regression analyses were used to identify independent predictors of the 6-month composite cognitive score.


RESULTS
In multivariable analyses, patient characteristics associated with cognitive decline included cerebrovascular disease (p = 0.009), peripheral vascular disease (p = 0.007), history of chronic disabling neurologic illness (p = 0.016), and living alone (p = 0.049), while the number of years of education (p = 0.001) was inversely related to cognitive decline. After adjustment for baseline patient risk factors, the presence of any postoperative complication(s) (p = 0.001) was also associated with cognitive decline while cardiopulmonary bypass time (p = 0.008) was inversely related to cognitive decline.


CONCLUSIONS
Patients with noncoronary manifestations of atherosclerosis, chronic disabling neurologic illness, or limited social support are at risk for cognitive decline after CABG surgery. In contrast, more years of education were associated with less cognitive decline. Preoperative assessment of risk factors identified in this study may be useful when counseling patients about the risk for cognitive decline following CABG surgery.
Ho
P Michael
PM
Denver Veterans Affairs Medical Center, Denver, Colorado, USA. michael.ho@uchsc.edu
Arciniegas
David B
DB
Grigsby
Jim
J
McCarthy
Martin
M
McDonald
Gerald O
GO
Moritz
Thomas E
TE
Shroyer
A Laurie
AL
Sethi
Gulshan K
GK
Henderson
William G
WG
London
Martin J
MJ
VillaNueva
Catherine B
CB
Grover
Frederick L
FL
Hammermeister
Karl E
KE
D000368:Aged; D003072:Cognition Disorders / Q000175:diagnosis / Q000209:etiology*; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D003324:Coronary Artery Disease / Q000601:surgery*; D005260:Female; D006787:Hospitals, Veterans; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009483:Neuropsychological Tests; D010043:Outcome and Process Assessment, Health Care; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology*; D011446:Prospective Studies; D012044:Regression Analysis; D012307:Risk Factors; D014481:United States