Scripties UMCG - Rijksuniversiteit Groningen
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Assessment of physical fitness and activity in cardiac surgery patients in relation to postoperativecognitive dysfunction

(2017) Tasbihgou, S.R. (Setayesh)

Introduction. Postoperative Cognitive Dysfunction (POCD) is a decline of performance in multiple cognitive domains that can last for long period of time after surgery. There is a growing body of evidence suggesting that inflammation plays a strong role in the development of POCD. The anti-inflammatory benefits of exercise may potentially be effective in reducing the incidence of POCD. The objective of this pilot cohort study was to determine the preoperative physical fitness of elective Coronary Artery Bypass Graft (CABG) patients, and its impact on the incidence of POCD.
Materials and methods. Approval was obtained from the Medical Ethical Committee to enrol 100 elective CABG patients. Questionnaires for fitness (SQUASH), general health (EQ-5D), health limitations (RAND-36), anxiety and depression (HADS), and quality of life (WHODAS) were completed prior to surgery and three months thereafter. Similarly, the CogState computerised cognitive test was used to measure cognitive performance one day prior to and three months after surgery. Fitness was determined using the Dutch authority for health and environment (Rijksinsituut voor Volksgezondheid en Milieu) norm requirements for physical activity. Additionally, handgrip strength was measured, get-up-and-go test was conducted, and routine perioperative laboratory measurements were recorded.
Results. Of the 100 patients who agreed to participate, only 86 were studied for this thesis; 14 patients are still awaiting surgery. According to the SQUASH survey, 73% (95% confidence interval: 62.4% - 82.0%) of patients appeared to be fit. There were no differences in results between the fit and unfit regarding the handgrip strength and get-up-and-go test. The results of the other questionnaires (EQ-5D, HADS, WHODAS) were similar between the two groups; the only notable difference was that the unfit patients assessed their role with regards to work and daily activities to be significantly more limited preoperatively (RAND-36). These limitations were due to both physical and emotional problems. In comparison to the fit group, the unfit group showed significantly higher levels of preoperative C-reactive-protein (CRP) (3.2 versus 8.8 mg/L) and peak postoperative CRP (159 versus 217 mg/L). The incidence of POCD was statistically similar for both fit (21.6%) and unfit (17.6%) patients.
Conclusion. The findings of this study show that the majority of elective CABG patients were physically active and fit. Physical inactivity did not correlate with postoperative complications, extended recovery or increased incidence of postoperative cognitive dysfunction. These findings are, however, limited to only low-risk cardiac patients in a small sample size. Nonetheless, the results show lower levels of inflammation in fit patients. A re-evaluation of fitness in a larger sample size – including both low and high risk cardiac patients – using different tests and measurements for physical activity (e.g. activity monitors, sitting-rising test) might prove to be more insightful on its effects on postoperative outcome.

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