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Preoperative walk distance predicts cognitive dysfunction after cardiac surgery
Preoperative 6-minute walk distance identified patients with cognitive dysfunction after cardiac surgery, researchers reported in the Annals of Thoracic Surgery.
Kazuhiro Hayashi, PT, MS, from Nagoya University Hospital in Japan, and colleagues analyzed 181 patients (mean age, 71 years) who underwent nonemergency cardiac surgery at a single center between March 2014 and August 2015 to determine whether low preoperative 6-minute walk distance was related to postoperative cognitive dysfunction.
Patients were stratified by whether they had postoperative cognitive dysfunction, defined as a decline of at least 2 points on the Mini-Mental State Examination score.
According to the researchers, 28% of patients in the cohort had postoperative cognitive dysfunction.
Median preoperative 6-minute walk distance was 400 m in those with postoperative cognitive dysfunction and 450 m in those without it, Hayashi and colleagues wrote.
In multivariable analyses, the researchers identified old age, high Mini-Mental State Examination score, low 6-minute walk distance and long ICU stay as independent predictors of postoperative cognitive dysfunction.
The OR of each 50-m increase in preoperative 6-minute walk distance for postoperative cognitive dysfunction was 0.807 (95% CI, 0.69-0.943), Hayashi and colleagues wrote.
“This study indicates that the easy and inexpensive 6-minute walk distance is a valuable assessment for identifying patients at a high risk for [postoperative cognitive dysfunction],” Hayashi said in a press release. “If we are able to identify patients who are at risk for [postoperative cognitive dysfunction], we can provide early treatment and encourage them to better understand the dysfunction.” – by Erik Swain
Disclosures: The authors report no relevant financial disclosures.
Perspective
Back to TopA patient’s fitness level, along with their nutritional status, mental health and cognition, in addition to their underlying heart condition, play an important role on their recovery following their procedure. This study tells us that relatively simple tests, such as a 6-minute walking distance assessment, can provide useful information on a patient’s risk of cognitive difficulties following their procedure. These can lead to longer-term issues that result in a lower quality of life and potential a loss of functional independence.
There is emerging information that optimizing patients’ physical and nutritional fitness and mindfulness before an operation may be of benefit. The process is called prehabilitation, or “prehab.” Prehab has been shown to be effective in improving patients’ functional reserve before their procedure in those undergoing major abdominal or orthopedic surgery, but has more recently been investigated in cardiac patients. Prehab can be used as part of an enhanced recovery program for the heart surgery patient.
There is a great quote from Dale M. Needham, MD, PhD, from Johns Hopkins Medical Institute, who has done a lot of great work on rehabilitation for ICU patients: “The head bone is connected to the body bone.” Both the patient and health care providers need to consider the value of preoperative optimization and early mobilization for vulnerable older adults undergoing cardiac surgery. However, more research is urgently needed.