The distance a patient can walk in 6 minutes before undergoing heart surgery may predict whether a patient will develop postoperative cognitive dysfunction (POCD) after the procedure, according to a study published in The Annals of Thoracic Surgery.
POCD, which is characterized by a weakness in the patient’s memory, concentration, and attention after surgery, can be a common occurrence after major surgery, especially among older adults. It can result not only in a greater risk of complications, but also a lesser quality of life, according to a media release from The Society of Thoracic Surgeons.
“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,” says Kazuhiro Hayashi, PT, MSc, of Nagoya University Hospital of Japan, in the release.
“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.”
The study included 181 patients (mean age 71.4 years) who were undergoing non-emergency heart surgery between March 2014 and August 2015 at Nagoya University Hospital.
In the study, the patients performed the 6MWD test upon admission for their respective procedures. Their 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 study results, a low 6MWD was an associated risk factor for POCD after cardiac surgery. In fact, the lower the 6MWD was, the more significant the postoperative reduction in cognitive function was. Among the study participants, 51 (28%) developed POCD, the release explains.
Rakesh C. Arora, MD, PhD, from St Boniface Hospital in Winnipeg, Canada, who was not involved with this research, notes in the release that the study highlights the need for a patient’s health care team to undertake a more detailed assessment of a patient’s physical fitness prior to surgical procedures. The 6MWD is an important component of this evaluation, Arora says.
Arora adds that 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 surgeries, 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 prior to the procedures, the release continues.
“Prehabilitation may be of benefit to patients with poor physical fitness by improving postoperative recover and post-discharge functional survival,” Arora says. “Patient self-management and follow-through are essential, however, as is the patient’s understanding of their health issues and their proposed plans of care.”
Hayashi agrees in the release 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 states.
[Source: The Society of Thoracic Surgeons]