title: Clinical impact of neurocognitive deficits after cardiac surgery.
abstract: OBJECTIVE
  Postoperative neurocognitive deficits (POCDs) have been found to occur frequently after cardiac surgery. Although POCDs have received significant attention in the medical literature and public media, the true clinical impact of these deficits on patient outcomes and quality of life (QOL) is not well defined.
  
  
  METHODS
  Neuropsychometric testing was performed on 696 patients undergoing coronary artery bypass surgery using a battery of tests divided into 4 domains; memory, attention, speed, and psychomotor function. These were performed preoperatively, at hospital discharge, and at 3 months postoperatively. POCDs were defined as a drop in scores by 1 standard deviation in 1 domain or more. QOL was assessed using Short Form 36 and clinical outcomes were recorded.
  
  
  RESULTS
  POCDs were identified in 265 (38%) patients at discharge and in 132 (19%) at 3 months. There was no observed difference in mortality or major morbidity in patients with or without POCDs. Predictors of POCDs at discharge were elevated preoperative creatinine (P = .04), increased cardiopulmonary bypass time (P = .005), and diabetes (P = .003). At 3 months, patients had improvements in both physical and mental components of QOL, independent of the occurrence of POCDs (P > .5). Independent predictors of improved QOL included younger age, severe preoperative anginal symptoms, normal left ventricular function, absence of postoperative wound infection, but not POCDs.
  
  
  CONCLUSIONS
  Neurocognitive deficits can be frequently detected on comprehensive neuropsychometric testing after cardiac surgery. However, they are not associated with any clinically important differences in patient outcome or in QOL after surgery.
authors.affiliation: Department of Cardiac Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Hadi D
authors.initials: HD
authors.lastname: Toeg
authors.forename: Howard
authors.initials: H
authors.lastname: Nathan
authors.forename: Fraser
authors.initials: F
authors.lastname: Rubens
authors.forename: Denise
authors.initials: D
authors.lastname: Wozny
authors.forename: Munir
authors.initials: M
authors.lastname: Boodhwani
mesh_terms: D016009:Chi-Square Distribution; D003072:Cognition Disorders / Q000175:diagnosis*; D001026:Coronary Artery Bypass / Q000523:psychology*; D003404:Creatinine / Q000097:blood; D003920:Diabetes Mellitus / Q000523:psychology; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D011237:Predictive Value of Tests; D011788:Quality of Life; D012307:Risk Factors; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires; D013997:Time Factors
chemical_list: D003404:Creatinine