TY - JOUR
T1 - Is cerebrovascular autoregulation associated with outcomes after major noncardiac surgery? : a prospective observational pilot study
AU - Chuan, Alwin
AU - Short, Timothy G.
AU - Peng, Alexander Z. Y.
AU - Wen, Shelly Y. B.
AU - Sun, Alice X.
AU - Ting, Timothy H.
AU - Wan, Anthony S.
AU - Pope, Linda
AU - Jaeger, Matthias
AU - Aneman, Anders
PY - 2019
Y1 - 2019
N2 - Background: Studies have identified multiple risk factors for development of cognitive decline after surgery. Impaired cerebrovascular autoregulation may be a contributor to postoperative cognitive decline. Methods: One hundred and forty patients admitted for major elective noncardiac surgery were recruited. Near-infrared spectroscopy was used to calculate the tissue oxygenation index of dynamic autoregulation (TOx). The primary endpoint was Day 3 cognitive recovery as assessed using the Postoperative Quality of Recovery Scale. The secondary endpoint was a combined major adverse event of death, acute myocardial infarction, cardiac arrest, stroke, pulmonary embolism, sepsis, and acute kidney injury at Day 30. Results: Higher optimal TOx values, signifying impaired autoregulation, were associated with worse outcomes. Patients who cognitively recovered at Day 3 (nÃÂ =ÃÂ 47) had lower optimal TOx values (TOxopt) than patients who did not recover (nÃÂ =ÃÂ 22): 0.06 (0.24) vs 0.18 (0.16) (mean [SD]), PÃÂ =ÃÂ 0.02. Patients who did not suffer a major adverse event (nÃÂ =ÃÂ 102) had lower TOxopt than patients who did (nÃÂ =ÃÂ 17): 0.09 (0.21) vs 0.20 (0.27), PÃÂ =ÃÂ 0.04. When dichotomized as having impaired or intact autoregulation based on TOxopt levels, a value of TOxopt ≥0.1 correctly identified 72.7% of patients who did not cognitively recover, OR 3.3 (1.1-9.9) (Odds ratio, [95% CI]), PÃÂ =ÃÂ 0.03. TOxopt ≥0.1 correctly identified 82.4% of patients who suffered a major adverse event, OR 4.7 (1.3-17.2), PÃÂ =ÃÂ 0.02. Conclusions: In older and higher risk patients having major noncardiac surgery, impaired cerebrovascular autoregulation was associated with failure of cognitive recovery in the early postoperative period and with 1-month mortality and morbidity.
AB - Background: Studies have identified multiple risk factors for development of cognitive decline after surgery. Impaired cerebrovascular autoregulation may be a contributor to postoperative cognitive decline. Methods: One hundred and forty patients admitted for major elective noncardiac surgery were recruited. Near-infrared spectroscopy was used to calculate the tissue oxygenation index of dynamic autoregulation (TOx). The primary endpoint was Day 3 cognitive recovery as assessed using the Postoperative Quality of Recovery Scale. The secondary endpoint was a combined major adverse event of death, acute myocardial infarction, cardiac arrest, stroke, pulmonary embolism, sepsis, and acute kidney injury at Day 30. Results: Higher optimal TOx values, signifying impaired autoregulation, were associated with worse outcomes. Patients who cognitively recovered at Day 3 (nÃÂ =ÃÂ 47) had lower optimal TOx values (TOxopt) than patients who did not recover (nÃÂ =ÃÂ 22): 0.06 (0.24) vs 0.18 (0.16) (mean [SD]), PÃÂ =ÃÂ 0.02. Patients who did not suffer a major adverse event (nÃÂ =ÃÂ 102) had lower TOxopt than patients who did (nÃÂ =ÃÂ 17): 0.09 (0.21) vs 0.20 (0.27), PÃÂ =ÃÂ 0.04. When dichotomized as having impaired or intact autoregulation based on TOxopt levels, a value of TOxopt ≥0.1 correctly identified 72.7% of patients who did not cognitively recover, OR 3.3 (1.1-9.9) (Odds ratio, [95% CI]), PÃÂ =ÃÂ 0.03. TOxopt ≥0.1 correctly identified 82.4% of patients who suffered a major adverse event, OR 4.7 (1.3-17.2), PÃÂ =ÃÂ 0.02. Conclusions: In older and higher risk patients having major noncardiac surgery, impaired cerebrovascular autoregulation was associated with failure of cognitive recovery in the early postoperative period and with 1-month mortality and morbidity.
UR - https://hdl.handle.net/1959.7/uws:64702
U2 - 10.1111/aas.13223
DO - 10.1111/aas.13223
M3 - Article
SN - 1399-6576
SN - 0001-5172
VL - 63
SP - 8
EP - 17
JO - Acta Anaesthesiologica Scandinavica
JF - Acta Anaesthesiologica Scandinavica
IS - 1
ER -