Impact of preoperative anxiety and depression on postoperative cognitive decline after coronary artery bypass grafting / Ugnė Norvaišaitė, Birutė Kumpaitienė

Section: Internal medicine, Anaesthesiology, Basic sciences, Cardiology, Gastroenterology, Dermatology poster.

Bibliogr.: p. 128

Introduction Postoperative cognitive dysfunction is a complication following cardiac surgery (1). Moreover, emotional distress including depression, anxiety can often be related to cognitive decline (2).The exact mechanisms of cognitive dysfunction following CABG remain unknown (3). Understanding the predictors associated with the objectionable disorder, and identifying modified risk factors, can accelerate recovery, and improve prevention and treatment after cardiac surgery (4). Aim To assess the dynamics of anxiety and depression and their relationship with cognitive impairment before and after coronary artery bypass grafting surgery. Methods A clinical, prospective, observational study was conducted at the Lithuanian University of Health Sciences Hospital Kaunas clinics. The study was approved by the Kaunas regional biomedical research ethics committee. Patients who underwent coronary artery bypass surgery were invited to the study. All patients included in the study underwent approved cognitive function tests one day before surgery and on days 7-10 after. Tests used were mini-mental state evaluation (MMSE),Rey auditory verbal learning test, Wechsler Adult Intelligence Scale, WAIS – digit span and WAIS– digit symbol substitution test. Only 65 patients who had not been diagnosed with impaired cognitive functions before the surgery participated in the study. All patients included in the study were also assessed for anxiety and depression before and 7-10 days after surgery by distributing HADS scales. The first stage of the study was attended by 65 patients, the second stage was completed by 45 patients whose data were analyzed with IBM SPSS Statistics 29. Data for qualitative variables are presented by number of respondents (n) and percentage expression. Chi-square (χ²) and/or Fisher's exact criteria were calculated to assess whether the signs are interrelated. Phi and Cramer's tests were used to assess the relationship between categorical data. McNemar’s testing assessed whether the CABG impacted the occurrence of depressive symptoms. Results The average age of the respondents was 66.98 years (SD 8.281). After performing the cognitive function assessment after surgery 19 (42.2%) were included in the group of patients with cognitive impairment, other 26 patients (57.8%) had no impairment. Depression was felt by 5(11.1%) before the operation and 14 (31.1%) after. Symptoms of anxiety appeared in 22 (48.9%)before and in 18 (40%) after. Impairment of cognitive functions is not related to symptoms of anxiety and depression felt before and after operation (p>0.05). Patients who experienced depression before the operation were more anxious after (χ2 =4.994 Phi=0.333 p=0.025). Postoperative anxiety significantly occurs together with postoperative depression (χ2 =4.994 Phi= 0.333 p=0.025). Patients who had anxiety symptoms before surgery were also anxious after(χ2 =6.537 Phi= 0.381 p=0.011). The rate of depression after surgery was higher - CABG was significantly associated with the occurrence of postoperative depression (p=0.012). Conclusions The study revealed that preoperative and postoperative depression and anxiety had no impact on cognitive function decline. The surgery was significantly associated with the occurrence of postoperative depression.