Short-term cognitive and functional decline in older patients undergoing elective cardiac surgery: preliminary results of a longitudinal study

Abstract

Aim: The implementation of new techniques has significantly reduced mortality and morbidity in older cardiovascular patients undergoing cardiac surgery. However, few studies have assessed post-surgery functional and cognitive outcomes in this demographic. This study aims to characterize baseline cognitive and functional status of patients undergoing elective cardiothoracic surgery (CS) and to evaluate their modifications over a 3-month follow-up.
Methods: Data were extracted from a prospective study starting May 2023. Patients aged 65+ undergoing elective CS received pre-operative geriatric assessments. Postoperative complications and delirium were monitored, with a 3-month follow-up assessing functional and cognitive status. Kruskal-Wallis and Fisher's tests analyzed clinical and demographic features, and linear regression examined the relationship between follow-up functional autonomy and preoperative cognitive status.
Results: Seventy-seven patients (median age: 72 [IQR, 68.00-75.25], 53% males) were included in the study, showing a median Instrumental Activities of Daily Living (IADL) of 8 [5.00-8.00]. The median pre-operative Montreal Cognitive Assessment (MoCA) was 22.88 [19.96-24.80]. 21.4% of patients with impaired cognitive performance at baseline experienced delirium, compared to 2.3% of those without impairment (p=0.052). At follow-up, 58 patients were re-assessed, showing a median IADL of 7.5 [5.00, 8.00] and an almost 64.3% prevalence of impaired cognitive performance on Telephone MoCA testing. At the linear regression analysis, pre-operative MoCA was correlated with three-month IADL decline [β = 0.144; 95% CI 0.044-0.243; p=0.005].
Conclusions: Routine cognitive assessments reveal significant cognitive deficits in older CS patients. Preliminary findings suggest a link between preoperative cognitive impairment and functional decline.