• Monique L Roberts, Hung-Mo Lin, Elizabeth Tinuoye, Edmond Cohen, Raja M Flores, Gregory W Fischer, and Menachem M Weiner.
• Department of Anesthesia and Critical Care, Hospital of University of Pennsylvania, Philadelphia, PA. Electronic address: Monique.Roberts@pennmedicine.upenn.edu.
• J. Cardiothorac. Vasc. Anesth. 2021 Feb 1; 35 (2): 542-550.

ObjectivesThis study was designed to investigate whether cerebral oxygen desaturations during thoracic surgery are predictive of patients' quality of recovery. As a secondary aim, the authors investigated the relationship among cerebral desaturations and postoperative delirium and hospital length of stay.DesignThis study was a prospective observational cohort study.SettingA single tertiary-care medical center from September 2012 through March 2014.PatientsAdult patients scheduled for elective pulmonary surgery requiring one-lung ventilation.InterventionsAll patients were monitored with the ForeSight cerebral oximeter.Measurements And Main ResultsThe primary assessment tool was the Postoperative Quality of Recovery Scale. Delirium was assessed using the Confusion Assessment Method. Of the 117 patients analyzed in the study, 60 of the patients desaturated below a cerebral oximetry level of 65% for a minimum of 3 minutes (51.3%). Patients who desaturated were significantly less likely to have cognitive recovery in the immediate postoperative period (p = 0.012), which did not persist in the postoperative period beyond day 0. Patients who desaturated also were more likely to have delirium (p = 0.048, odds ratio 2.81 [95% CI 1.01-7.79]) and longer length of stay (relative duration 1.35, 95% CI 1.05-1.73; p = 0.020).ConclusionsIntraoperative cerebral oxygen desaturations, frequent during one-lung ventilation, are associated significantly with worse early cognitive recovery, high risk of postoperative delirium, and prolonged length of stay. Large interventional studies on cerebral oximetry in the thoracic operating room are warranted.Published by Elsevier Inc.

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