Cerebral Oxygen Desaturation Predicts Cognitive Decline and Longer Hospital Stay After Cardiac Surgery

James P. Slater, Theresa Guarino, Jessica Stack, Kateki Vinod, Rami T. Bustami, John M. Brown, Alejandro L. Rodriguez, Christopher J. Magovern, Thomas Zaubler, Kenneth Freundlich, Grant V.S. Parr

Research output: Contribution to journalArticle

376 Citations (Scopus)

Abstract

Background: Previous studies have reported an 11% to 75% incidence of postoperative cognitive decline among cardiac surgery patients. The INVOS Cerebral Oximeter (Somanetics Corp, Troy, MI) is a Food and Drug Administration approved device that measures regional cerebral oxygen (rSo2) saturation. The purpose of this study is to examine whether decreased rSo2 predicts cognitive decline and prolonged hospital stay after coronary artery bypass grafting (CABG). Methods: The rSo2 was monitored intraoperatively in a cohort of primary CABG patients. Patients were prospectively randomized to a blinded control group or an unblinded intervention group. Cognitive function was assessed preoperatively, postoperatively, and at 3 months using a battery of standardized neurocognitive tests. Cognitive decline was defined as a decrease of one standard deviation or more in performance on at least one neurocognitive measure. The rSo2 desaturation score was calculated by multiplying rSo2 below 50% by time (seconds). Multivariate logistic regression models were used to assess cognitive decline and hospital stay. The change in cognitive performance was also assessed using a multivariate linear regression model. Results: Patients with rSo2 desaturation score greater than 3,000%-second had a significantly higher risk of early postoperative cognitive decline [p = 0.024]. Patients with rSo2 desaturation score greater than 3,000%-second also had a near threefold increased risk of prolonged hospital stay (>6 days) [p = 0.007]. Conclusions: Intraoperative cerebral oxygen desaturation is significantly associated with an increased risk of cognitive decline and prolonged hospital stay after CABG.

Original languageEnglish (US)
Pages (from-to)36-45
Number of pages10
JournalAnnals of Thoracic Surgery
Volume87
Issue number1
DOIs
StatePublished - Jan 1 2009

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Thoracic Surgery
Length of Stay
Oxygen
Coronary Artery Bypass
Linear Models
Logistic Models
United States Food and Drug Administration
Cognition
Cognitive Dysfunction
Equipment and Supplies
Control Groups
Incidence

All Science Journal Classification (ASJC) codes

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Slater, James P. ; Guarino, Theresa ; Stack, Jessica ; Vinod, Kateki ; Bustami, Rami T. ; Brown, John M. ; Rodriguez, Alejandro L. ; Magovern, Christopher J. ; Zaubler, Thomas ; Freundlich, Kenneth ; Parr, Grant V.S. / Cerebral Oxygen Desaturation Predicts Cognitive Decline and Longer Hospital Stay After Cardiac Surgery. In: Annals of Thoracic Surgery. 2009 ; Vol. 87, No. 1. pp. 36-45.
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title = "Cerebral Oxygen Desaturation Predicts Cognitive Decline and Longer Hospital Stay After Cardiac Surgery",
abstract = "Background: Previous studies have reported an 11{\%} to 75{\%} incidence of postoperative cognitive decline among cardiac surgery patients. The INVOS Cerebral Oximeter (Somanetics Corp, Troy, MI) is a Food and Drug Administration approved device that measures regional cerebral oxygen (rSo2) saturation. The purpose of this study is to examine whether decreased rSo2 predicts cognitive decline and prolonged hospital stay after coronary artery bypass grafting (CABG). Methods: The rSo2 was monitored intraoperatively in a cohort of primary CABG patients. Patients were prospectively randomized to a blinded control group or an unblinded intervention group. Cognitive function was assessed preoperatively, postoperatively, and at 3 months using a battery of standardized neurocognitive tests. Cognitive decline was defined as a decrease of one standard deviation or more in performance on at least one neurocognitive measure. The rSo2 desaturation score was calculated by multiplying rSo2 below 50{\%} by time (seconds). Multivariate logistic regression models were used to assess cognitive decline and hospital stay. The change in cognitive performance was also assessed using a multivariate linear regression model. Results: Patients with rSo2 desaturation score greater than 3,000{\%}-second had a significantly higher risk of early postoperative cognitive decline [p = 0.024]. Patients with rSo2 desaturation score greater than 3,000{\%}-second also had a near threefold increased risk of prolonged hospital stay (>6 days) [p = 0.007]. Conclusions: Intraoperative cerebral oxygen desaturation is significantly associated with an increased risk of cognitive decline and prolonged hospital stay after CABG.",
author = "Slater, {James P.} and Theresa Guarino and Jessica Stack and Kateki Vinod and Bustami, {Rami T.} and Brown, {John M.} and Rodriguez, {Alejandro L.} and Magovern, {Christopher J.} and Thomas Zaubler and Kenneth Freundlich and Parr, {Grant V.S.}",
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Slater, JP, Guarino, T, Stack, J, Vinod, K, Bustami, RT, Brown, JM, Rodriguez, AL, Magovern, CJ, Zaubler, T, Freundlich, K & Parr, GVS 2009, 'Cerebral Oxygen Desaturation Predicts Cognitive Decline and Longer Hospital Stay After Cardiac Surgery', Annals of Thoracic Surgery, vol. 87, no. 1, pp. 36-45. https://doi.org/10.1016/j.athoracsur.2008.08.070

Cerebral Oxygen Desaturation Predicts Cognitive Decline and Longer Hospital Stay After Cardiac Surgery. / Slater, James P.; Guarino, Theresa; Stack, Jessica; Vinod, Kateki; Bustami, Rami T.; Brown, John M.; Rodriguez, Alejandro L.; Magovern, Christopher J.; Zaubler, Thomas; Freundlich, Kenneth; Parr, Grant V.S.

In: Annals of Thoracic Surgery, Vol. 87, No. 1, 01.01.2009, p. 36-45.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Cerebral Oxygen Desaturation Predicts Cognitive Decline and Longer Hospital Stay After Cardiac Surgery

AU - Slater, James P.

AU - Guarino, Theresa

AU - Stack, Jessica

AU - Vinod, Kateki

AU - Bustami, Rami T.

AU - Brown, John M.

AU - Rodriguez, Alejandro L.

AU - Magovern, Christopher J.

AU - Zaubler, Thomas

AU - Freundlich, Kenneth

AU - Parr, Grant V.S.

PY - 2009/1/1

Y1 - 2009/1/1

N2 - Background: Previous studies have reported an 11% to 75% incidence of postoperative cognitive decline among cardiac surgery patients. The INVOS Cerebral Oximeter (Somanetics Corp, Troy, MI) is a Food and Drug Administration approved device that measures regional cerebral oxygen (rSo2) saturation. The purpose of this study is to examine whether decreased rSo2 predicts cognitive decline and prolonged hospital stay after coronary artery bypass grafting (CABG). Methods: The rSo2 was monitored intraoperatively in a cohort of primary CABG patients. Patients were prospectively randomized to a blinded control group or an unblinded intervention group. Cognitive function was assessed preoperatively, postoperatively, and at 3 months using a battery of standardized neurocognitive tests. Cognitive decline was defined as a decrease of one standard deviation or more in performance on at least one neurocognitive measure. The rSo2 desaturation score was calculated by multiplying rSo2 below 50% by time (seconds). Multivariate logistic regression models were used to assess cognitive decline and hospital stay. The change in cognitive performance was also assessed using a multivariate linear regression model. Results: Patients with rSo2 desaturation score greater than 3,000%-second had a significantly higher risk of early postoperative cognitive decline [p = 0.024]. Patients with rSo2 desaturation score greater than 3,000%-second also had a near threefold increased risk of prolonged hospital stay (>6 days) [p = 0.007]. Conclusions: Intraoperative cerebral oxygen desaturation is significantly associated with an increased risk of cognitive decline and prolonged hospital stay after CABG.

AB - Background: Previous studies have reported an 11% to 75% incidence of postoperative cognitive decline among cardiac surgery patients. The INVOS Cerebral Oximeter (Somanetics Corp, Troy, MI) is a Food and Drug Administration approved device that measures regional cerebral oxygen (rSo2) saturation. The purpose of this study is to examine whether decreased rSo2 predicts cognitive decline and prolonged hospital stay after coronary artery bypass grafting (CABG). Methods: The rSo2 was monitored intraoperatively in a cohort of primary CABG patients. Patients were prospectively randomized to a blinded control group or an unblinded intervention group. Cognitive function was assessed preoperatively, postoperatively, and at 3 months using a battery of standardized neurocognitive tests. Cognitive decline was defined as a decrease of one standard deviation or more in performance on at least one neurocognitive measure. The rSo2 desaturation score was calculated by multiplying rSo2 below 50% by time (seconds). Multivariate logistic regression models were used to assess cognitive decline and hospital stay. The change in cognitive performance was also assessed using a multivariate linear regression model. Results: Patients with rSo2 desaturation score greater than 3,000%-second had a significantly higher risk of early postoperative cognitive decline [p = 0.024]. Patients with rSo2 desaturation score greater than 3,000%-second also had a near threefold increased risk of prolonged hospital stay (>6 days) [p = 0.007]. Conclusions: Intraoperative cerebral oxygen desaturation is significantly associated with an increased risk of cognitive decline and prolonged hospital stay after CABG.

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