School of Health Sciences, City, University of London, Northampton Square, London EC1V 0HB, UK.
St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London EC1V 0HB, UK.
Eur J Cardiovasc Nurs. 2022 Apr 9;21(3):192-204. doi: 10.1093/eurjcn/zvab086.
Postoperative cognitive dysfunction (POCD) is often experienced by cardiac surgery patients; however, it is not known if some groups of patients experience this more frequently or severely than others.The aim of this systematic review was to identify preoperative and postoperative predictors of cognitive dysfunction in adults following cardiac surgery.
Eight bibliographic databases were searched (January 2005 to March 2021) in relation to cardiac surgery and cognition. Studies including adult patients who had undergone open cardiac surgery and using a validated measurement of cognitive function were included. Full-text review for inclusion, quality assessment, and data extraction were undertaken independently by two authors. A total of 2870 papers were identified, of which 36 papers met the inclusion criteria and were included in the review. The majority were prospective observational studies [n = 28 (75.7%)]. In total, 61 independent predictors (45 preoperative and 16 postoperative) were identified as significant in at least one study; advancing age and education level appear important. Age has emerged as the most common predictor of cognitive outcome.
Although a number of predictors of POCD have been identified, they have inconsistently been reported as significantly affecting cognitive outcome. Consistent with previous research, our findings indicate that older patients and those with lower educational levels should be prioritized when developing and trialling interventions to improve cognitive function. These findings are less than surprising if we consider the methodological shortcomings of included studies. It is evident that further high-quality research exploring predictors of POCD is required.
This review was registered on Prospero, CRD42020167037.
心脏手术后患者常发生术后认知功能障碍（POCD），但尚不清楚哪些患者比其他患者更频繁或更严重地发生这种情况。本系统评价的目的是确定心脏手术后成人认知功能障碍的术前和术后预测因素。
共检索了 8 个文献数据库（2005 年 1 月至 2021 年 3 月），涉及心脏手术和认知。纳入了接受开放性心脏手术并使用经过验证的认知功能测量方法的成年患者的研究。两名作者独立进行了纳入标准的全文审查、质量评估和数据提取。共确定了 2870 篇论文，其中 36 篇论文符合纳入标准并纳入了本综述。大多数为前瞻性观察性研究[ n = 28（75.7％）]。共有 61 个独立预测因素（45 个术前和 16 个术后）至少在一项研究中被确定为显著；年龄增长和教育程度似乎很重要。年龄已成为认知结果的最常见预测因素。
尽管已经确定了一些 POCD 的预测因素，但它们作为影响认知结果的重要因素的报告并不一致。与先前的研究一致，我们的研究结果表明，应优先考虑年龄较大和教育程度较低的患者，以制定和试验改善认知功能的干预措施。如果我们考虑到纳入研究的方法学缺陷，这些发现就不足为奇了。显然，需要进一步开展高质量的研究来探索 POCD 的预测因素。
本综述已在 Prospero 上注册，注册号为 CRD42020167037。
