Seher İlhan, İlknur Hatice Akbudak, Aslı Mete Yıldız, Turan Evran, Ece Tütüncüler, Ali Demirtaş, Edip Gönüllü
Anatolian Current Medical Journal - 2025;7(6):847-854
Aims: This study aims to investigate the association between perioperative optic nerve sheath diameter (ONSD), a noninvasive marker of intracranial pressure, and the incidence of postoperative cognitive dysfunction (POCD) on postoperative days 8 and 30 in patients undergoing elective open-heart surgery with cardiopulmonary bypass. Methods: It was designed as a prospective, observational, single-institution study conducted at a tertiary care hospital. Seventy-nine adult patients scheduled for elective open-heart surgery using cardiopulmonary bypass were included. Perioperative ONSD measurements were obtained at five predefined time points during the perioperative period. Cognitive function was assessed using the Mini-Mental State Examination (MMSE) preoperatively and on the 8th and 30th postoperative days. POCD was defined as a clinically significant decline in MMSE score based on the Reliable Change Index (RCI), using a test-retest reliability coefficient of 0.95. An RCI <-1.96 indicated POCD. Results: On postoperative day-8, 44 patients (55.7%) developed POCD, and these patients had a significantly higher median age compared to those without POCD (70.0 vs. 66.0 years, p=0.002). By day-30, POCD persisted in only seven patients (8.9%). Lower preoperative cognitive reserve was also significantly associated with the development of POCD (p<0.05). No significant association was found between perioperative ONSD values and POCD on either postoperative day (p>0.05). Conclusion: Perioperative ONSD was not significantly associated with the development of POCD on postoperative days 8 or 30 in patients undergoing elective open-heart surgery. Instead, preoperative cognitive reserve and older age emerged as stronger predictors of POCD, underscoring the importance of baseline cognitive assessment and patient characteristics in evaluating perioperative risk.
