Cognitive Outcomes and Functional Performance for Patients After Open Heart Surgery

Abstract

Context: Open heart surgery is a lifesaving procedure for patients who need coronary artery bypass graft (CABG) and heart valve replacement or repair (HVR). However, it also carries a risk of cognitive and functional performance injuries. Between 30% to 60% of patients undergoing open heart surgery worldwide are at high risk of cognitive and functional performance injuries.

Aim: The study aimed to assess cognitive outcomes and functional performance of patients after open heart surgery.

Methods: A descriptive exploratory design was applied to achieve the aim of this study on a purposive sample of 103 adults who were scheduled for elective open-heart surgery (CABG and valve replacement or repair). Montreal Cognitive Assessment (MOCA); Physical Self-Maintenance Scale (Activities of Daily Living) (PSMS) tests were used to determine the effect of cardiac surgery on cognitive outcomes and functional performance abilities of patients undergoing cardiac surgery. Both scales were used twice for each patient (preoperative and postoperative).

Results: The current study shows a statistically significant deterioration in all cognitive functions (visuospatial &executive function, naming, short-term memory recall task, attention, language, abstraction, orientation) (p=0.000). A total cognitive score reveals that 68% of the patients had normal cognitive function before open heart surgery, significantly decreasing to 55.3% after surgery. The functional outcomes measured by the assessment of activity of daily living shows that 100% of patient were independent before open heart surgery and significantly decreased to 74.8% postoperatively.

Conclusion: It can be concluded that open heart surgery impacts cognitive functions, particularly in domains of visuospatial and executive function, memory, and attention. Besides, the everyday functional performance includes toileting, feeding, dressing, grooming, physical ambulation, and bathing). Instrumental activities of daily living (IADL), which include the ability to use the telephone, shopping, food preparation, housekeeping, laundry, away for transportation, responsibility for following their medication regimens, and ability to handle finances, were also affected. Nurses caring for patients undergoing open heart surgery should consider cognitive limitations when giving them health education and discharge instruction, their readiness to learn should be considered before any educational event. Further studies should be carried out to identify the factors that may contribute to the impairment of cognitive function and functional performance for patients undergoing cardiac surgery.