Cognitive and Psychological Outcomes of Cardiac Surgery

            It is not only important to assess the efficacy of a surgery or a procedure based on its direct, physical effects, but also based on its long-term, often unseen and indirect effects. These effects are the cognitive and psychological outcomes people experience such as decreased quality of life through increased rates of depression or decreased cognitive abilities. Previously, literature on this topic was quite scarce; however, research on this is now increasing, particularly for patients undergoing cardiac surgery. Cardiac surgery is often quite invasive, and thus incredibly intense for patients¹. Up to 25% of postoperative cardiac surgery patients can develop PTSD and, depending on the type of cardiac surgery, approximately 30-60% of patients can go on to develop depression¹. These numbers are alarming, clearly justifying the need for a deeper understanding of how patient’s cognitive and psychological abilities change following cardiac surgery.

            Rothenhäusler et al. (2005) conducted one of the earlier studies to investigate the psychiatric and psychosocial effects of cardiopulmonary bypass². Following patients one-year after surgery, the researchers administered neuropsychological tests to understand the before and after effects of surgery². Directly following surgery, about 30% of patients had developed delirium, while a smaller percentage of people had developed depression and PTSD². However, these psychological changes did not last for a majority of the patients in the long-term as most patients returned to their preoperative psychological state². Although psychological outcomes did not last in the long-term, changes in cognitive function did². Given this cognitive decline, as well as lasting psychological effects in a select few patients, it is important to understand these changes in great detail in order to develop effective interventions to reduce these effects.

            For a deeper understanding of the psychological outcomes of cardiac surgery, Tully (2012) reviewed current research on the depressive episodes that patients experience after surgery³. Tully (2012) found that much of the current literature comes to varying conclusions about changes in mental health after surgery, citing that these studies have highly heterogeneous methodologies in the neuropsychological assessments that are used, and that these studies do little to control other factors that may influence psychological outcomes³. With this, it thus becomes incredibly difficult to understand the true psychological effects of cardiac surgery, putting those who do develop some issues at risk as proper interventions have not been developed. This is clear through Whalley et al. (2014), which assesses a set of psychological interventions in present cardiac rehabilitation programs⁴. After analyzing multiple interventions, the reviewers found that these interventions only led to minimal improvement in levels of depression in patients, and that there was much is still unknown about what makes a postoperative cardiac psychological intervention successful⁴.

            It is clear that some patients experience psychological or cognitive issues to some extent following cardiac surgery. However, there is a lot of uncertainty about the details of these outcomes, such as how they arise as well as how various factors that might interact to produce these effects. It is necessary for medical professionals to have this knowledge so that better interventions can be developed. Even if a majority of patients do not continue to experience psychological problems in the long-term, there are a select few who do. There is thus is a definite need for proper interventions to allay these effects, especially as some of these patients also experience cognitive dysfunction.

References:

(1) Ackerman MG, Shapiro PA. Psychological Effects of Invasive Cardiac Surgery and Cardiac Transplantation. Handbook of Psychocardiology. 2016:567-584. doi:10.1007/978-981-287-206-7_26.

(2) Rothenhäusler HB, Grieser B, Nollert G, Reichart B, Schelling G, Kapfhammer HP. Psychiatric and psychosocial outcome of cardiac surgery with cardiopulmonary bypass: a prospective 12-month follow-up study. Gen Hosp Psychiatry. 2005;27(1):18-28. doi:10.1016/j.genhosppsych.2004.09.001

(3) Tully PJ. Psychological depression and cardiac surgery: a comprehensive review. J Extra Corpor Technol. 2012;44(4):224-232.

(4) Whalley B, Thompson DR, Taylor RS. Psychological Interventions for Coronary Heart Disease: Cochrane Systematic Review and Meta-analysis. International Journal of Behavioral Medicine. 2012;21(1):109-121. doi:10.1007/s12529-012-9282-x.