Abstract 2327: Smoking History Predicts Increased Risk of Cognitive Decline After Cardiac Surgery
Introduction: Previous studies have reported an incidence of postoperative cognitive decline or disorientation among cardiac surgery patients ranging from 11–75%. While the relationship between smoking and cardiovascular disease has been established, few studies have focused on the effect of smoking history on cognitive decline in the cardiac surgery population. In this study, we examined the association between smoking history and cognitive decline in coronary artery bypass graft (CABG) patients.
Methods: Prospectively collected data were obtained from a clinical trial comparing outcomes in CABG patients who underwent intraoperative cerebral oximetry monitoring and those managed according to standard practice. Cognitive function was assessed preoperatively and at discharge in 240 patients using a battery of standardized neurocognitive tests. Cognitive decline was defined as a decrease of one standard deviation or more in performance on at least one neurocognitive measure. A multivariate logistic regression model was used to examine the independent effect of smoking history on cognitive decline. The model was adjusted for age, gender, race, hypertension, left ventricular ejection fraction, history of myocardial infarction, renal function, and intraoperative cerebral oximetry monitoring.
Results: Approximately 68% of the study sample reported a history of smoking. Results from the multivariate logistic model (table⇓) showed that CABG patients with a history of smoking had a significantly higher risk of cognitive decline compared to those without a smoking history [Odds Ratio (OR) = 1.96, p = 0.034]. An increased risk of cognitive decline was also significantly associated with prolonged intraoperative forebrain desaturation and increased score on the Delirium Rating Scale.
Conclusion: This study showed that smoking history is significantly associated with an increased risk of cognitive decline after CABG.