[Cognitive impairment after major surgical operations].

OBJECTIVE

To study the characteristics of cognitive impairment after extensive surgical operations of various profiles, to develop tactics of cerebroprotection, as well as personalized prevention of cognitive impairment (CI).

MATERIAL AND

METHODS

The study included 277 patients who underwent elective extensive cardiac surgery (coronary bypass surgery, prosthetics of the aortic heart valve) and oncological (for malignant neoplasms of the thoracic or abdominal cavities) profile. All patients underwent a comprehensive clinical, laboratory, and instrumental examination (including neuropsychological testing using the MoCA, FAB scales) in the preoperative and intraoperative periods, as well as 10 days after surgery.

RESULTS

Deferred CI after cardiac surgery was diagnosed in 30-36% of patients, and after oncological surgery in 31% of patients. The incidence of acute clinical types of postoperative cerebral dysfunction also had no statistically significant differences: perioperative stroke (2-4% and 2%), symptomatic delirium of the early postoperative period (14-17% and 11%, respectively). Postoperative brain dysfunction was diagnosed after 44% of cardiac surgeries and 34% of oncosurgical operations. Risk factors for deferred CI after coronary bypass surgery: age over 65 years; stenotic atherosclerosis of the brachiocephalic arteries. During aortic valve replacement, the risk factors for deferred CI are: total cholesterol >5.1 mmol/L; very low-density lipoproteins >1.2 mmol/L; low-density lipoproteins >3.2 mmol/L; platelet count<220×109/L; hematocrit<28%. In oncosurgery, the risk factors for delayed CI are: age >70 years, lack of work in the specialty; Charlson's index comorbidity score >5 points; ASA physical status >Class III; MoCA test scores<20 points.

CONCLUSION

Most of the risk factors for deferred cognitive impairment are preoperative, which allows ahead additional assessment of the possibility of modifying the surgical technique and accompanying therapy, as well as designing of personalized tactics of cerebroprotection and prevention of cognitive impairment.