Quantified pre-operative neurological dysfunction predicts outcome after coronary artery bypass surgery

Abstract

Aims

Patients undergoing coronary artery bypass grafting (CABG) surgery may experience neurological impairment. We examined whether intraoperative regional cerebral oxygen saturation (rSO2) and neurological dysfunction prior to surgery, measured by robotic technology, are important predictors of post-operative performance following CABG surgery.

Methods

Adult patients undergoing CABG surgery were recruited for this single-center prospective observational study. Intraoperative rSO2 was captured using the FORESIGHT cerebral oximeter. Neurological assessment was performed pre-operatively and 3 months following surgery using robotic technology and a standardized pen-and-paper assessment. Linear regression models were generated to determine the predictive ability of both intraoperative rSO2 and pre-operative performance on post-operative neurological outcome.

Results

Forty patients had complete data available for analysis. Quantified pre-operative performance accounted for a significantly larger amount of variance in post-operative outcome compared to intraoperative rSO2. In particular, pre-operative scoring on a cognitive visuospatial task accounted for 82.2% of variance in post-operative performance (b = 0.937, t(37) = 12.98, p = 1.28e−5).

Discussion

Our results suggest that pre-operative performance is a stronger indicator of post-operative neurological outcome than intraoperative rSO2, and should be included as an important variable when elucidating the relationship between cerebral oxygen levels and post-operative neurological impairment. Rigorous neurological assessment prior to surgery can provide valuable information about each individual patient’s path to recovery.

Conclusion

Using robotic technology, quantified neurological impairment prior to CABG surgery may better predict post-operative neurological outcomes, compared to intraoperative rSO2 values.

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Funding

This work was supported by the Southeastern Ontario Academic Medical Organization (SEAMO) Innovation Fund.

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Corresponding author

Correspondence to J. Gordon Boyd.

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Conflicts of interest

JSS, AGH, TS, DP, DP, GB have nothing to disclose. SHS is the inventor of the KINARM robot and co-founder of BKIN Technologies. JGB receives a stipend from the Trillium of Life Network for his role as a hospital donation physician.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Human and animal rights

The study was approved by the Queen's University and Affiliated Hospital's Health Sciences Research Ethics Board.

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All participants provided informed consent prior to participation in this study.

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Semrau, J.S., Scott, S.H., Hamilton, A.G. et al. Quantified pre-operative neurological dysfunction predicts outcome after coronary artery bypass surgery. Aging Clin Exp Res 32, 289–297 (2020). https://doi.org/10.1007/s40520-019-01184-9

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Keywords

  • Post-operative cognitive dysfunction
  • Coronary artery bypass surgery
  • Neurological assessment
  • Robotic technology
  • Cerebral oximetry