Impact of Postoperative Cognitive Dysfunction after Cardiac Surgery on Midterm Outcomes and Mortality

Abstract

Background: Postoperative cognitive dysfunction (POCD) that is a common neurological side effect after cardiac surgery, is becoming more widely acknowledged as a possible marker of adverse outcomes. But its effect on mortality and midterm results is still unclear, especially in developing countries.

Aim of the Study: To investigate the impact of POCD on midterm clinical outcomes and mortality following cardiac surgery.

Patients and Methods: This prospective observational cohort study was conducted on 200 adult patients undergoing cardiac surgery at the National Heart Institute, Cairo, Egypt, and Shebein Elkom Teaching Hospital, Menoufia. Patients were categorized into POCD and non-POCD groups based on postoperative cognitive assessment using the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA).

Results: Postoperatively, MMSE scores were significantly lower in the POCD group compared to the non-POCD group. Patients with POCD had significantly prolonged ICU stays and total hospital stays. The incidence of postoperative complications was significantly higher in the POCD group. Functional dependence, as assessed by Activities of Daily Living (ADL), was also significantly more prevalent among POCD patients. Regarding mortality outcomes, although mortality at 1 week and 1 month were higher in the POCD group, it did not reach statistically significant difference. While at 1 year the POCD group showed a significantly higher mortality rate (9.0% vs 1.0%, p = 0.019).

Conclusion: POCD is associated with adverse postoperative outcomes following cardiac surgery, including increased complications, prolonged hospitalization, greater functional dependence, and higher midterm mortality. Early identification and targeted management of POCD may improve patient outcomes and reduce postoperative morbidity and mortality.