scholarly journals Risk Factors Associated with Cognitive Decline after Cardiac Surgery: A Systematic Review

2015 ◽  
Vol 2015 ◽  
pp. 1-12 ◽  
Author(s):  
Nikil Patel ◽  
Jatinder S. Minhas ◽  
Emma M. L. Chung
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Cognitive Decline ◽  
New Technologies ◽  
Perioperative Risk ◽  
Factors Associated ◽  
Perioperative Risk Factors ◽  
Postoperative Cognitive Decline

Modern day cardiac surgery evolved upon the advent of cardiopulmonary bypass machines (CPB) in the 1950s. Following this development, cardiac surgery in recent years has improved significantly. Despite such advances and the introduction of new technologies, neurological sequelae after cardiac surgery still exist. Ischaemic stroke, delirium, and cognitive impairment cause significant morbidity and mortality and unfortunately remain common complications. Postoperative cognitive decline (POCD) is believed to be associated with the presence of new ischaemic lesions originating from emboli entering the cerebral circulation during surgery. Cardiopulmonary bypass was thought to be the reason of POCD, but randomised controlled trials comparing with off-pump surgery show contradictory results. Attention has now turned to the growing evidence that perioperative risk factors, as well as patient-related risk factors, play an important role in early and late POCD. Clearly, identifying the mechanism of POCD is challenging. The purpose of this systematic review is to discuss the literature that has investigated patient and perioperative risk factors to better understand the magnitude of the risk factors associated with POCD after cardiac surgery.

Non-dialysis-dependent renal dysfunction and cardiac surgery—an assessment of perioperative risk factors

2005 ◽  
Vol 62 (1) ◽  
pp. 64-70 ◽  
Author(s):  
Gopal C. Kowdley ◽  
Shishir Maithal ◽  
Shafqat Ahmed ◽  
David Naftel ◽  
Robert Karp
Keyword(s):  
Risk Factors ◽  
Cardiac Surgery ◽  
Renal Dysfunction ◽  
Perioperative Risk ◽  
Perioperative Risk Factors

scholarly journals Is postoperative cognitive decline after cardiac surgery associated with plasma beta amyloid 1–42 levels?

2022 ◽  
Vol 17 (1) ◽  
Author(s):  
Zrinka Požgain ◽  
Grgur Dulić ◽  
Goran Kondža ◽  
Siniša Bogović ◽  
Ivan Šerić ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Coronary Artery ◽  
Cognitive Decline ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Off Pump ◽  
Bypass Group ◽  
Postoperative Cognitive Decline ◽  
Pump Coronary Artery Bypass

Abstract Background Postoperative cognitive decline following cardiac surgery is one of the frequently reported complications affecting postoperative outcome, characterized by impairment of memory or concentration. The aetiology is considered multifactorial and the research conducted so far has presented contradictory results. The proposed mechanisms to explain the cognitive decline associated with cardiac surgery include the neurotoxic accumulation of β-amyloid (Aβ) proteins similar to Alzheimer's disease. The comparison of coronary artery bypass grafting procedures concerning postoperative cognitive decline and plasmatic Aβ1-42 concentrations has not yet been conducted. Methods The research was designed as a controlled clinical study of patients with coronary artery disease undergoing surgical myocardial revascularization with or without the use of a cardiopulmonary bypass machine. All patients completed a battery of neuropsychological tests and plasmatic Aβ1-42 concentrations were collected. Results The neuropsychological test results postoperatively were significantly worse in the cardiopulmonary bypass group and the patients had larger shifts in the Aβ1-42 preoperative and postoperative values than the group in which off-pump coronary artery bypass was performed. Conclusions The conducted research confirmed the earlier suspected association of plasmatic Aβ1-42 concentration to postoperative cognitive decline and the results further showed that there were less changes and lower concentrations in the off-pump coronary artery bypass group, which correlated to less neurocognitive decline. There is a lot of clinical contribution acquired by this research, not only in everyday decision making and using amyloid proteins as biomarkers, but also in the development and application of non-pharmacological and pharmacological neuroprotective strategies.

Risk Factors for Opioid Use After Anterior Cruciate Ligament Reconstruction

2019 ◽  
Vol 47 (9) ◽  
pp. 2130-2137 ◽  
Author(s):  
Anita G. Rao ◽  
Priscilla H. Chan ◽  
Heather A. Prentice ◽  
Elizabeth W. Paxton ◽  
Tadashi T. Funahashi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Anterior Cruciate Ligament ◽  
Anterior Cruciate Ligament Reconstruction ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Perioperative Risk ◽  
Cruciate Ligament Reconstruction ◽  
Factors Associated ◽  
Perioperative Risk Factors ◽  
Anterior Cruciate

Background: The misuse of opioid medications has contributed to a significant national crisis affecting public health as well as patient morbidity and medical costs. After orthopaedic surgical procedures, patients may require prescription (Rx) opioid medication, which can fuel the opioid epidemic. Opioid Rx usage after anterior cruciate ligament reconstruction (ACLR) is not well characterized. Purpose: To determine baseline utilization of Rx opioids in patients undergoing ACLR and examine demographic, patient, and surgical factors associated with greater and prolonged postoperative opioid utilization. Study Design: Cohort study; Level of evidence, 3. Methods: Primary elective ACLRs were identified using Kaiser Permanente’s ACLR registry (2005-2015). We studied the association of perioperative risk factors on the number of dispensed opioid Rx in the early (0-90 days) and late (91-360 days) postoperative recovery periods using logistic regression. Results: Of 21,202 ACLRs, 25.5% used at least 1 opioid Rx in the 1-year preoperative period; 17.7% and 2.7% used ≥2 opioid Rx in the early and late recovery periods, respectively. Risk factors associated with greater opioid Rx in both the early and the late periods included the following: ≥2 preoperative opioid Rx, age ≥20 years, American Society of Anesthesiologists classification ≥3, other activity at the time of injury, chondroplasty, chronic pulmonary disease, and substance abuse. Risk factors associated with opioid Rx use during the early period only included the following: other race, acute injury, meniscal injury repair, multiligament injury, and dementia/psychosis. Risk factors associated with greater opioid Rx during the late period only included the following: 1 preoperative opioid Rx, female sex, body mass index ≥25 kg/m2, motor vehicle accident as the mechanism of injury, and hypertension. Conclusion: A quarter of ACLR patients had at least 1 opioid Rx before the procedure, but usage dropped to 2.7% toward the end of the postoperative year. We identified several perioperative risk factors for greater and prolonged opioid usage after ACLR.

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