Neurocognitive Outcomes

The brain is the most complex and sensitive organ in the body, so it is no wonder that major physiological disruptions can affect it in several ways. Functional disturbances in neurocognitive performance are the most common events impacting patients following cardiac surgery, yet are often not discussed with patients. Delirium occurs in up to 50% of older patients and can have long-term consequences including persistent cognitive decline. Other neurocognitive disorders such as delayed neurocognitive recovery (often described as poor short-term memory or “brain fog”) can be seen in around one-third of patients in the days to weeks following surgery. Even at 3 months, >10% of patients may suffer from a neurocognitive disorder. Impaired baseline cognitive function is a risk factor, amplified by the inflammatory and other responses to major surgery. It is possible that anaesthesia and intensive care unit management strategies can play a protective role to some extent, and there is increasing evidence that anaesthesia per se is not harmful in most circumstances. Perioperative care involves identifying at-risk individuals and implementing multidisciplinary care throughout the hospital stay. This presentation will discuss evidence for underlying mechanisms and what can be done now and in the future to mitigate this. It is also likely that better preparing patients for surgery, both physically and cognitively, may improve their outcomes.