Is cerebrovascular autoregulation associated with outcomes after major noncardiac surgery?: a prospective observational pilot study

Alwin Chuan, Timothy G. Short, Alexander Z. Y. Peng, Shelly Y.B. Wen, Alice X. Sun, Timothy H. Ting, Anthony S. Wan, Linda Pope, Matthias Jaeger, Anders Aneman

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Background: Studies have identified multiple risk factors for development of cognitive decline after surgery. Impaired cerebrovascular autoregulation may be a contributor to postoperative cognitive decline. Methods: One hundred and forty patients admitted for major elective noncardiac surgery were recruited. Near-infrared spectroscopy was used to calculate the tissue oxygenation index of dynamic autoregulation (TOx). The primary endpoint was Day 3 cognitive recovery as assessed using the Postoperative Quality of Recovery Scale. The secondary endpoint was a combined major adverse event of death, acute myocardial infarction, cardiac arrest, stroke, pulmonary embolism, sepsis, and acute kidney injury at Day 30. Results: Higher optimal TOx values, signifying impaired autoregulation, were associated with worse outcomes. Patients who cognitively recovered at Day 3 (n = 47) had lower optimal TOx values (TOxopt) than patients who did not recover (n = 22): 0.06 (0.24) vs 0.18 (0.16) (mean [SD]), P = 0.02. Patients who did not suffer a major adverse event (n = 102) had lower TOxopt than patients who did (n = 17): 0.09 (0.21) vs 0.20 (0.27), P = 0.04. When dichotomized as having impaired or intact autoregulation based on TOxopt levels, a value of TOxopt ≥0.1 correctly identified 72.7% of patients who did not cognitively recover, OR 3.3 (1.1-9.9) (Odds ratio, [95% CI]), P = 0.03. TOxopt ≥0.1 correctly identified 82.4% of patients who suffered a major adverse event, OR 4.7 (1.3-17.2), P = 0.02. Conclusions: In older and higher risk patients having major noncardiac surgery, impaired cerebrovascular autoregulation was associated with failure of cognitive recovery in the early postoperative period and with 1-month mortality and morbidity.

LanguageEnglish
Pages8-17
Number of pages10
JournalActa Anaesthesiologica Scandinavica
Volume63
Issue number1
Early online date5 Aug 2018
DOIs
Publication statusPublished - 1 Jan 2019
Externally publishedYes

Fingerprint

Observational Studies
Homeostasis
Near-Infrared Spectroscopy
Heart Arrest
Pulmonary Embolism
Acute Kidney Injury
Postoperative Period
Sepsis
Stroke
Odds Ratio
Myocardial Infarction
Morbidity
Mortality

Keywords

  • cerebral autoregulation
  • intraoperative
  • monitoring
  • postoperative complications

Cite this

Chuan, Alwin ; Short, Timothy G. ; Peng, Alexander Z. Y. ; Wen, Shelly Y.B. ; Sun, Alice X. ; Ting, Timothy H. ; Wan, Anthony S. ; Pope, Linda ; Jaeger, Matthias ; Aneman, Anders. / Is cerebrovascular autoregulation associated with outcomes after major noncardiac surgery? a prospective observational pilot study. In: Acta Anaesthesiologica Scandinavica. 2019 ; Vol. 63, No. 1. pp. 8-17.
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title = "Is cerebrovascular autoregulation associated with outcomes after major noncardiac surgery?: a prospective observational pilot study",
abstract = "Background: Studies have identified multiple risk factors for development of cognitive decline after surgery. Impaired cerebrovascular autoregulation may be a contributor to postoperative cognitive decline. Methods: One hundred and forty patients admitted for major elective noncardiac surgery were recruited. Near-infrared spectroscopy was used to calculate the tissue oxygenation index of dynamic autoregulation (TOx). The primary endpoint was Day 3 cognitive recovery as assessed using the Postoperative Quality of Recovery Scale. The secondary endpoint was a combined major adverse event of death, acute myocardial infarction, cardiac arrest, stroke, pulmonary embolism, sepsis, and acute kidney injury at Day 30. Results: Higher optimal TOx values, signifying impaired autoregulation, were associated with worse outcomes. Patients who cognitively recovered at Day 3 (n = 47) had lower optimal TOx values (TOxopt) than patients who did not recover (n = 22): 0.06 (0.24) vs 0.18 (0.16) (mean [SD]), P = 0.02. Patients who did not suffer a major adverse event (n = 102) had lower TOxopt than patients who did (n = 17): 0.09 (0.21) vs 0.20 (0.27), P = 0.04. When dichotomized as having impaired or intact autoregulation based on TOxopt levels, a value of TOxopt ≥0.1 correctly identified 72.7{\%} of patients who did not cognitively recover, OR 3.3 (1.1-9.9) (Odds ratio, [95{\%} CI]), P = 0.03. TOxopt ≥0.1 correctly identified 82.4{\%} of patients who suffered a major adverse event, OR 4.7 (1.3-17.2), P = 0.02. Conclusions: In older and higher risk patients having major noncardiac surgery, impaired cerebrovascular autoregulation was associated with failure of cognitive recovery in the early postoperative period and with 1-month mortality and morbidity.",
keywords = "cerebral autoregulation, intraoperative, monitoring, postoperative complications",
author = "Alwin Chuan and Short, {Timothy G.} and Peng, {Alexander Z. Y.} and Wen, {Shelly Y.B.} and Sun, {Alice X.} and Ting, {Timothy H.} and Wan, {Anthony S.} and Linda Pope and Matthias Jaeger and Anders Aneman",
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Chuan, A, Short, TG, Peng, AZY, Wen, SYB, Sun, AX, Ting, TH, Wan, AS, Pope, L, Jaeger, M & Aneman, A 2019, 'Is cerebrovascular autoregulation associated with outcomes after major noncardiac surgery? a prospective observational pilot study', Acta Anaesthesiologica Scandinavica, vol. 63, no. 1, pp. 8-17. https://doi.org/10.1111/aas.13223

Is cerebrovascular autoregulation associated with outcomes after major noncardiac surgery? a prospective observational pilot study. / Chuan, Alwin; Short, Timothy G.; Peng, Alexander Z. Y.; Wen, Shelly Y.B.; Sun, Alice X.; Ting, Timothy H.; Wan, Anthony S.; Pope, Linda; Jaeger, Matthias; Aneman, Anders.

In: Acta Anaesthesiologica Scandinavica, Vol. 63, No. 1, 01.01.2019, p. 8-17.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Is cerebrovascular autoregulation associated with outcomes after major noncardiac surgery?

T2 - Acta Anaesthesiologica Scandinavica

AU - Chuan, Alwin

AU - Short, Timothy G.

AU - Peng, Alexander Z. Y.

AU - Wen, Shelly Y.B.

AU - Sun, Alice X.

AU - Ting, Timothy H.

AU - Wan, Anthony S.

AU - Pope, Linda

AU - Jaeger, Matthias

AU - Aneman, Anders

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Studies have identified multiple risk factors for development of cognitive decline after surgery. Impaired cerebrovascular autoregulation may be a contributor to postoperative cognitive decline. Methods: One hundred and forty patients admitted for major elective noncardiac surgery were recruited. Near-infrared spectroscopy was used to calculate the tissue oxygenation index of dynamic autoregulation (TOx). The primary endpoint was Day 3 cognitive recovery as assessed using the Postoperative Quality of Recovery Scale. The secondary endpoint was a combined major adverse event of death, acute myocardial infarction, cardiac arrest, stroke, pulmonary embolism, sepsis, and acute kidney injury at Day 30. Results: Higher optimal TOx values, signifying impaired autoregulation, were associated with worse outcomes. Patients who cognitively recovered at Day 3 (n = 47) had lower optimal TOx values (TOxopt) than patients who did not recover (n = 22): 0.06 (0.24) vs 0.18 (0.16) (mean [SD]), P = 0.02. Patients who did not suffer a major adverse event (n = 102) had lower TOxopt than patients who did (n = 17): 0.09 (0.21) vs 0.20 (0.27), P = 0.04. When dichotomized as having impaired or intact autoregulation based on TOxopt levels, a value of TOxopt ≥0.1 correctly identified 72.7% of patients who did not cognitively recover, OR 3.3 (1.1-9.9) (Odds ratio, [95% CI]), P = 0.03. TOxopt ≥0.1 correctly identified 82.4% of patients who suffered a major adverse event, OR 4.7 (1.3-17.2), P = 0.02. Conclusions: In older and higher risk patients having major noncardiac surgery, impaired cerebrovascular autoregulation was associated with failure of cognitive recovery in the early postoperative period and with 1-month mortality and morbidity.

AB - Background: Studies have identified multiple risk factors for development of cognitive decline after surgery. Impaired cerebrovascular autoregulation may be a contributor to postoperative cognitive decline. Methods: One hundred and forty patients admitted for major elective noncardiac surgery were recruited. Near-infrared spectroscopy was used to calculate the tissue oxygenation index of dynamic autoregulation (TOx). The primary endpoint was Day 3 cognitive recovery as assessed using the Postoperative Quality of Recovery Scale. The secondary endpoint was a combined major adverse event of death, acute myocardial infarction, cardiac arrest, stroke, pulmonary embolism, sepsis, and acute kidney injury at Day 30. Results: Higher optimal TOx values, signifying impaired autoregulation, were associated with worse outcomes. Patients who cognitively recovered at Day 3 (n = 47) had lower optimal TOx values (TOxopt) than patients who did not recover (n = 22): 0.06 (0.24) vs 0.18 (0.16) (mean [SD]), P = 0.02. Patients who did not suffer a major adverse event (n = 102) had lower TOxopt than patients who did (n = 17): 0.09 (0.21) vs 0.20 (0.27), P = 0.04. When dichotomized as having impaired or intact autoregulation based on TOxopt levels, a value of TOxopt ≥0.1 correctly identified 72.7% of patients who did not cognitively recover, OR 3.3 (1.1-9.9) (Odds ratio, [95% CI]), P = 0.03. TOxopt ≥0.1 correctly identified 82.4% of patients who suffered a major adverse event, OR 4.7 (1.3-17.2), P = 0.02. Conclusions: In older and higher risk patients having major noncardiac surgery, impaired cerebrovascular autoregulation was associated with failure of cognitive recovery in the early postoperative period and with 1-month mortality and morbidity.

KW - cerebral autoregulation

KW - intraoperative

KW - monitoring

KW - postoperative complications

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