POST OPERATIVE COGNITIVE DYSFUNCTION AFTER CARDIAC SURGERIES

Abstract



Background:
Post Operative Cognitive Dysfunction ( POCD) is a less known but serious complication after any major surgery especially after open cardiac surgeries. Cognitive decline after major surgeries can be transient. But the impact of POCD in the post operative recovery is troublesome which makes it a topic of interest. POCD can range from impaired memory, attention, learning, executive function to impairment of psychomotor dexterity. It can also be accompanied by behavioural changes. POCD by definition requires both pre- and postoperative psychometric tests. Though there are several studies on POCD worldwide, a reliable test has not been identified to diagnose POCD.
Aim :
The aim of this study is to establish the incidence of POCD and devise a reliable methodical test to diagnose POCD with available resources at Dept of Cardiothoracic Surgery, Govt Stanley hospital.
Settings and Design :
Department of cardio thoracic surgery , retrospective study Methods and Material: INCLUSION CRITERIA : All patients who underwent elective open cardiac surgeries in department of CTS in Stanley medical college EXCLUSION CRITERIA: 1. All patients who had previous cognitive disorders 2. Patients with psychiatric illnesses 3. Patients with pre existing cerebral dysfunction, pulmonary, renal insufficiency SAMPLE SIZE : 100 PATIENTS DURATION : Cases operated from 2015 to 2017 Statistical analysis used: SAS
Results:
1.Incidence of POCD is 4 6% at the time of discharge, 29% at six weeks and 18% at six months after surgery 2.Montreal cognitive Asseessment (MoCA) as a preoperative screening test and Wisconsin Card Sorting Test (WCST) as a post operative confirmatory test are reliable tests in our setup 3.Incidence of POCD is higher with CABG ON PUMP, followed by other open cardiac cases such as valvular replacements especially ones involving aortic valves.
Conclusions:
POCD is a serious complication of cardiac surgery. The incidence of POCD is the highest at the time of discharge which gradually decreases over the period of time. MoCA and WCST are useful tests for cognition where in the patients are subjected to simple methods of cognitive functional analysis.

Comments


Article Info