The Influence of Preoperative Physical Activity on Intraoperative Brain Function in Cardiac Surgical patients

TL;DR

Higher preoperative physical activity is linked to reduced abnormal brain activity during heart surgery, which may lower the risk of postoperative delirium.

Contribution

This study shows a dose-response relationship between preoperative physical activity and reduced intraoperative EEG burst suppression.

Findings

Each unit increase in the PCS12 score was associated with a 3.3% decrease in burst suppression duration.

Patients in the highest quartile of physical activity had a 55.4% reduction in burst suppression duration compared to the lowest quartile.

No significant association was found between physical activity and cerebral desaturation.

Abstract

Preoperative physical activity and intraoperative brain health are recognized to influence postoperative delirium (POD). Electroencephalogram (EEG) burst suppression and cerebral desaturation are indicators of abnormal intraoperative brain health. Our study aimed to investigate the associations between preoperative physical activity and intraoperative EEG burst suppression and cerebral desaturation.

We retrospectively analyzed data from 67 patients from one of the institutions participating in a multisite randomized controlled trial, PANDORA, involving patients undergoing cardiac surgery. The preoperative PCS12 score calculated using the SF12 questionnaire was used as an indicator of preoperative physical activity. Intraoperative EEG and cerebral oximetry data (not the current standard of care in this facility) were collected, and the anesthesiologists were blinded to the information. We analyzed the following associations between the PCS12 score and i) burst suppression duration, ii) the number of cerebral desaturations, and iii) the number of observations with concurrent cerebral desaturation and burst suppression using a generalized linear model. The results are presented as percentage changes in outcomes, and a 95% C.I. p value < 0.05 was considered to indicate statistical significance.

Each unit increase in the PCS12 score was associated with a 3.3% decrease in the duration of burst suppression (−3.3 [−5.3, −1.2], p value = 0.002). The duration of burst suppression decreased by 29.2% with each successive quartile increase in the PCS-12 score, indicating a dose−response relationship (−29.2 [−41.6, −16], p < 0.001). Specifically, the patients in the last three quartiles exhibited a 55.4% reduction in BSD compared to those in the first quartile (−55.4 [−74.4, −24.6], p = 0.002) (Fig. 2). We did not observe any significant association between the PCS12 score and cerebral desaturation.

Decreased preoperative physical activity, as measured by the SF-12 questionnaire, is significantly associated with increased EEG burst suppression duration. Preoperative physical activity did not show any association with cerebral desaturations and concurrent cerebral desaturation and burst suppression.

ClinicalTrials.gov Identifier- NCT04093219

https://clinicaltrials.gov/ct2/show/NCT04093219

Principal Investigator - Balachundhar Subramaniam

Date of registration - September 13, 2019

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