Simple walking test helps predict risk for cognitive issues after heart surgery

May 10, 2018, Elsevier

The distance a patient can walk in 6-minutes before a heart operation may be a clue to whether that patient will develop problems with memory, concentration, and attention after the procedure, according to a study published online today in The Annals of Thoracic Surgery.

Broadly speaking, a decline in cognitive performance after is known as postoperative cognitive dysfunction (POCD). With POCD, a patient's mental aptitude is weaker after surgery, resulting not only in a greater risk of complications, but also a lesser quality of life. Cognitive deterioration is increasingly recognized as a common occurrence after major surgery, especially among older adult .

"This study indicates that the easy and inexpensive 6-minute walk distance (6MWD) is a valuable assessment for identifying patients at a high risk for POCD," said Kazuhiro Hayashi, PT, MSc, of Nagoya University Hospital in Japan. "If we are able to identify patients who are at risk for POCD, we can provide early treatment and encourage them to better understand the dysfunction."

For this study, Hayashi and colleagues identified 181 patients who were undergoing non-emergency heart surgery between March 2014 and August 2015 at Nagoya University Hospital. The mean age of the patients was 71.4 years.

Patients performed the 6MWD test upon admission for their operations. Functional exercise capacity was measured by having patients walk the length of a predetermined course at their own pace while attempting to cover as much ground as possible in 6 minutes. The distance covered in that duration was measured to the nearest meter. According to the results of this study, a low 6MWD was an associated risk factor for POCD after cardiac surgery. In fact, the lower the 6MWD was, the more significant the reduction in cognitive function postoperatively was. Of the study participants, 51 (28 percent) developed POCD.

"It is increasingly recognized that a patient's fitness level has an impact on how well he/she does after a surgical procedure," said Rakesh C. Arora, MD, Ph.D., of St. Boniface Hospital in Winnipeg, Canada, who was not involved with this research. "This study further highlights the need for the health care team to undertake a more detailed assessment of patients' physical fitness before the operation. The 6MWD is an important component of this evaluation."

According to Dr. Arora, the identification of patients at risk for POCD and other cognitive disorders should alert the health care team to consider modifying anesthetic and medication choices during-and-after the operations, as well as assist with discharge planning as patients transition to home. In addition, the health care team should consider strategies, such as prehabilitation, to optimize the patients' fitness before their operations. Dr. Arora explained that prehabilitation includes a combination of exercise training, education, and social support intended to improve patients' physical and psychological readiness for surgery.

"Prehabilitation may be of benefit to patients with poor physical fitness by improving postoperative recovery and post-discharge functional survival," said Dr. Arora. "Patient self-management and follow-through are essential, however, as is the patient's understanding of their health issues and their proposed plan of care."

Dr. Hayashi agrees that a multidisciplinary approach, which includes elements such as prehabilitation, is key to a better assessment and treatment outcome. "Precise preoperative risk assessment for postoperative complications is critical, and when indicated, supervised exercise before an operation should be recommended to improve functional exercise capacity before heart surgery," he said.

Explore further: Diabetes boosts risk of cognitive issues after surgery, especially in seniors, study finds

More information: Kazuhiro Hayashi et al, Preoperative 6-Minute Walk Distance Is Associated With Postoperative Cognitive Dysfunction, The Annals of Thoracic Surgery (2018). DOI: 10.1016/j.athoracsur.2018.03.010

Related Stories

Diabetes boosts risk of cognitive issues after surgery, especially in seniors, study finds

October 22, 2017
Older patients with diabetes may be at an 84 percent higher risk of developing postoperative cognitive dysfunction (POCD) than those who are not diabetic, suggests new research being presented at the ANESTHESIOLOGY 2017 annual ...

What we know and don't know about memory loss after surgery

April 27, 2018
Two years ago, Dr. Daniel Cole's 85-year-old father had heart bypass surgery. He hasn't been quite the same since.

Age is not a risk factor for complications after surgery among older patients

January 12, 2018
Among older patients, frailty and cognitive impairment before surgery are associated with developing complications after surgery, but age is not, a new study suggests.

Anesthesia professionals not sufficiently aware of risks of postoperative cognitive side effects

August 19, 2014
Postsurgical cognitive side effects can have major implications for the level of care, length of hospital stay, and the patient's perceived quality of care, especially in elderly and fragile patients. A nationwide survey ...

Simple measures can reduce post-operative cognitive dysfunction in older patients

June 22, 2016
Post-operative cognitive dysfunction (POCD), a condition mostly observed in older patients following surgery under general anesthesia, is characterized by impaired memory and concentration. The impairment may be temporary ...

Older adults who are frail more likely to experience delirium after surgery

January 26, 2018
Older adults who are frail are twice as likely to experience delirium following elective surgery than those of an older age, a new study suggests.

Recommended for you

Clues found to early lung transplant failure

May 21, 2018
Among organ transplant patients, those receiving new lungs face a higher rate of organ failure and death compared with people undergoing heart, kidney and liver transplants. One of the culprits is inflammation that damages ...

Blood type O patients may have higher risk of death from severe trauma

May 1, 2018
Blood type O is associated with high death rates in severe trauma patients, according to a study published in the open access journal Critical Care that involved 901 Japanese emergency care patients.

Brains, eyes, testes: off-limits for transplants?

April 28, 2018
Since the world's first successful organ transplant in 1954—a kidney—the discipline has advanced to the point where a wounded soldier could have his penis and scrotum replaced in a groundbreaking operation last month.

Emergency treatment by older surgeons linked to slightly lower death rates

April 26, 2018
Patients undergoing emergency surgery who are treated by older surgeons (aged 60 or over) have slightly lower death rates in the first few weeks after their operation than patients treated by younger surgeons (aged less than ...

Bionic suit helps paralyzed patients stand and walk again

April 25, 2018
Patients undergoing physical rehabilitation at Rush for paralyzing injuries are being aided by a robotic suit designed to help raise people to full height and walk.

Johns Hopkins performs first total penis and scrotum transplant in the world

April 23, 2018
Many soldiers returning from combat bear visible scars, or even lost limbs, caused by blasts from improvised explosive devices, or IEDs. However, some servicemen also return with debilitating hidden injuries—the loss of ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.