Predictors of cognitive recovery after cardiac surgery.

BACKGROUND: Postoperative neurocognitive decline occurs frequently. Although predictors of cognitive injury have been well examined, factors that modulate recovery have not. We sought to determine the predictors of cognitive recovery after initial injury following cardiac surgery. METHODS: Two hundred eighty-one patients previously enrolled in cognitive studies who experienced cognitive decline 6 weeks after cardiac surgery were retrospectively evaluated. Eligible patients completed a battery of neurocognitive measures and quality-of-life assessments at baseline, 6 weeks, and 1 year after surgery. Factor analysis was conducted to calculate the cognitive index (Cl), a unified, continuous measure of cognitive function. Cognitive recovery was defined as 1-year Cl greater than baseline Cl. Potential predictors of cognitive recovery including patient characteristics, quality-of-life factors, comorbidities, medications, and intraoperative variables were assessed with multivariable regression modeling; P < 0.05 was considered significant. RESULTS: Of the 229 patients in our final data set, 103 (45%) demonstrated cognitive recovery after initial decline in Cl at 6 weeks. Multivariable analyses revealed that more education (odds ratio [OR] 1.332 [1.131-1.569], P < 0.001), baseline Cl (OR 0.987 [0.976-0.998], P = 0.02), less decline in CI at 6 weeks (OR 1.044 [1.014-1.075], P = 0.004), and greater activities of,daily living at 6 weeks (OR 0.891 [0.810-0.981], P = 0.02) were significant predictors of cognitive recovery. CONCLUSION: Cognitive recovery occurred in approximately one half of the cardiac surgical patients experiencing early decline. The association between cognitive recovery and Instrumental Activities of Daily Living scores at 6 weeks merits further investigation as it is the only potentially modifiable predictor of recovery. (Anesth Analg 2013;116:435-42)