Neurocognitive impairment and driving performance after coronary artery bypass surgery

Objective: Neurocognitive impairment is common after cardiac surgery but few studies have examined the relationship between postoperative neuropsychological test performance and everyday behavior. The influence of postoperative cognitive impairment on car driving has previously not been investigated. The purpose of this study was to evaluate neurocognitive function and driving performance after coronary artery bypass grafting (CABG). Methods: Twenty-seven patients who underwent coronary artery bypass grafting with standard cardiopulmonary bypass technique and 20 patients scheduled for percutaneous coronary intervention (PCI) under local anesthesia (control group) were enrolled in this prospective study conducted from April 1999 to September 2000. Complete data were obtained in 23 and 19 patients, respectively. The patients underwent neuropsychological examination with a test battery including 12 tests, a standardized on-road driving test and a test in an advanced driving simulator before and 4-6 weeks after intervention. Results: More patients in the coronary artery bypass grafting group (n = 11, 48%) than in the percutaneous coronary intervention group (n = 2, 10%) showed a cognitive decline after intervention (P = 0.01). In the on-road driving test, patients who underwent coronary artery bypass grafting deteriorated after surgery in the cognitive demanding parts like traffic behavior (P = 0.01) and attention (P = 0.04). Patients who underwent percutaneous intervention deteriorated in maneuvering of the vehicle (P = 0.04). No deterioration was detected in the simulator in any of the groups after intervention. Patients with a cognitive decline after intervention also tended to drop in the on-road driving scores to a larger extent than did patients without a cognitive decline. Conclusion: This study indicates that cognitive functions important for safe driving may be influenced after cardiac surgery. (C) 2002 Elsevier Science B.V. All rights reserved.