The following is a summary of “History of Psychoactive Medication a Risk Factor for Neurocognitive Decline After Cardiac Surgery,” published in the December 2023 issue of Surgery by Stanley et al.
Neurocognitive decline (NCD) is a pervasive issue post-cardiac surgery, profoundly impacting patient outcomes and quality of life. Identifying risk factors is pivotal for surgeons to implement preventive strategies, optimize modifiable risks, and offer informed guidance to patients concerning potential risks and prognosis. In a prospective cohort study at a single academic center involving 104 cardiac surgery patients, the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) was used to assess neurocognitive function preoperatively, on postoperative day four, and at day 30 post-surgery. NCD, defined as a decline in RBANS scaled score of < −8 from baseline to postoperative day 4, was observed in 42.9% of patients.
Intriguingly, patients with a history of consuming psychoactive medications before surgery demonstrated a substantially higher incidence of acute postoperative NCD (56.8%) compared to those without such medication history (31.9%), highlighting a significant association (P < 0.03). However, there was no significant correlation between the historical use of beta-blockers, calcium-channel blockers, statins, and oral hypoglycemic medications and the occurrence of NCD.
Furthermore, simple linear regression analysis revealed no link between changes in RBANS total scaled score and postoperative opioid usage. Remarkably, no divergence in the incidence of NCD was observed at the one-month follow-up. These findings strongly suggest that patients with a history of consuming psychoactive medications before cardiac surgery have a heightened risk of experiencing acute postoperative neurocognitive decline, emphasizing the need for cautious preoperative evaluation and awareness of this risk factor in clinical decision-making to optimize patient outcomes.
Source: sciencedirect.com/science/article/abs/pii/S0022480423005711
