Journal
INTERNATIONAL JOURNAL OF CARDIOLOGY
Volume 289, Issue -, Pages 43-49Publisher
ELSEVIER IRELAND LTD
DOI: 10.1016/j.ijcard.2019.04.065
Keywords
Coronary artery bypass grafting surgery; Cardiac surgery; Post-operative cognitive decline; Delirium; Dementia
Categories
Funding
- Australian Government Research Training Program Scholarship
- NHMRC-ARC Boosting Dementia Research Leadership Fellowship [GNT1135676]
- National Heart Foundation of Australia Future Leader Fellowship [FLF100412]
- NHMRC-ARC Career Development Fellowship [GNT1161506]
- Wellcome Trust Intermediate Clinical Fellowship [WT107467]
- NHMRC-ARC Dementia Research Development Fellowship [GNT1097397]
- National Heart Foundation of Australia Vanguard grant [101758 - VG 2017]
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Background: Cognitive impairments, including delirium, are common after coronary artery bypass grafting (CABG) surgery, as described in over three decades of research. Our aim was to pool estimates across the literature for the first-time, relative to time (from pre- to post-CABG) and diagnosis (cognitive impairment, delirium and dementia). Methods: A systematic search of four databases was undertaken. 215 studies incorporating data from 91,829 patients were used to estimate the prevalence of cognitive impairments pre- and post-CABG, including delirium and dementia post-CABG, using random effects meta-analyses. Results: Pre-surgical cognitive impairment was seen in 19% of patients. Post-operatively, cognitive impairment was seen in around 43% of patients acutely; this resolved to 19% at 4-6 months and then increased to 25% of patients between 6-months to 1-year post-operatively. In the long term, between 1 and 5-years post-operatively, cognitive impairment increased and was seen in nearly 40% of patients. Post-operative delirium was apparent in 18% of CABG patients which increased to 24% when a diagnostic instrument was utilized alongside clinical criteria. Dementia was present in 7% of patients 5-7 years post-surgery. Conclusion: The results of this meta-analysis demonstrate that cognitive impairment and delirium are major issues in CABG patients which require specific attention. It is imperative that appropriate methods for investigating cognitive impairment, and screening for delirium using a diagnostic instrument, occur in both pre-and postCABG settings. (c) 2019 The Authors. Published by Elsevier B.V.
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