Optic nerve sheath diameter and postoperative cognitive dysfunction after cardiac surgery: a prospective observational study

Abstract

Aims: This study aims to investigate the association between perioperative optic nerve sheath diameter (ONSD), a noninvasive marker of intracranial pressure, and the incidence of postoperative cognitive dysfunction (POCD) on postoperative days 8 and 30 in patients undergoing elective open-heart surgery with cardiopulmonary bypass. Methods: It was designed as a prospective, observational, single-institution study conducted at a tertiary care hospital. Seventy nine adult patients scheduled for elective open-heart surgery using cardiopulmonary bypass were included. Perioperative ONSD measurements were obtained at five predefined time points during the perioperative period. Cognitive function was assessed using the Mini-Mental State Examination (MMSE) preoperatively and on the 8th and 30th postoperative days. POCD was defined as a clinically significant decline in MMSE score based on the Reliable Change Index (RCI), using a test-retest reliability coefficient of 0.95. An RCI <–1.96 indicated POCD. Results: On postoperative day-8, 44 patients (55.7%) developed POCD, and these patients had a significantly higher median age compared to those without POCD (70.0 vs. 66.0 years, p=0.002). By day-30, POCD persisted in only seven patients (8.9%). Lower preoperative cognitive reserve was also significantly associated with the development of POCD (p<0.05). No significant association was found between perioperative ONSD values and POCD on either postoperative day (p>0.05). Conclusion: Perioperative ONSD was not significantly associated with the development of POCD on postoperative days 8 or 30 in patients undergoing elective open-heart surgery. Instead, preoperative cognitive reserve and older age emerged as stronger predictors of POCD, underscoring the importance of baseline cognitive assessment and patient characteristics in evaluating perioperative risk.

Keywords

• Cardiac surgery
• Mini-Mental State Examination
• optic nerve sheath
• postoperative cognitive dysfunction

Kardiyak cerrahi sonrası 8. ve 30. günlerde optik sinir kılıfı çapı ile postoperatif kognitif disfonksiyon arasında anlamlı bir ilişkinin olmaması: prospektif gözlemsel çalışma

Abstract

Bu çalışmanın amacı, elektif kardiyopulmoner bypass ile açık kalp cerrahisi geçiren hastalarda, intrakraniyal basıncın noninvaziv bir göstergesi olan perioperatif optik sinir kılıf çapı (OSKÇ) ile postoperatif bilişsel disfonksiyon (POCD) insidansı arasındaki ilişkiyi araştırmaktır. Çalışma, prospektif, gözlemsel ve tek merkezli olarak bir üçüncü basamak hastanede yürütülmüştür. Kardiyopulmoner bypass kullanılarak elektif açık kalp cerrahisi planlanan 79 yetişkin hasta çalışmaya dahil edilmiştir. Perioperatif OSKÇ ölçümleri, beş önceden tanımlanmış perioperatif zaman noktasında elde edilmiştir. Bilişsel fonksiyon, ameliyat öncesinde ve postoperatif 8. ile 30. günlerde Mini Mental Durum Değerlendirmesi (MMSE) ile değerlendirilmiştir. POCD, test-tekrar test güvenilirlik katsayısı 0,95 olan Güvenilir Değişim İndeksi (RCI) esas alınarak, MMSE skorunda klinik olarak anlamlı bir düşüş şeklinde tanımlanmıştır. RCI < –1,96 POCD varlığı olarak kabul edilmiştir. Postoperatif 8. günde 44 hastada (%55,7) POCD gelişmiş ve bu hastaların medyan yaşları, POCD gelişmeyenlere kıyasla anlamlı derecede yüksek bulunmuştur (70,0 vs. 66,0 yıl, p=0,002). Ancak 30. günde yalnızca 7 hastada (%8,9) POCD devam etmiştir. Perioperatif OSKÇ değerleri ile POCD gelişimi arasında, gerek postoperatif 8. günde gerekse 30. günde anlamlı bir ilişki bulunmamıştır (p>0,05). Elektif açık kalp cerrahisi geçiren hastalarda perioperatif OSKÇ ile POCD gelişimi arasında istatistiksel olarak anlamlı bir ilişki saptanmamıştır.

Keywords

• Kardiyak Cerrahi
• Mini Mental Durum Muayenesi
• Optik Sinir Kılıfı
• Postoperatif Kognitif Disfonksiyon

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