Early Postoperative Cognitive Performance After Total Arch Replacement: A Prospective Observational Study

Early postoperative cognitive trajectories following total arch replacement remain insufficiently characterized. This study evaluated serial postoperative recovery patterns with particular focus on cognitive performance during the first postoperative week.

Adult patients undergoing elective total arch replacement were enrolled. Recovery was assessed using the Postoperative Quality of Recovery Scale (PostopQRS) at baseline within 14 days before surgery and postoperatively at 3 h and 1, 3, and 7 days after extubation. Cognitive recovery was evaluated according to the revised PostopQRS cognitive recovery algorithm. Recovery trajectories including other PostopQRS domains were summarized descriptively.

Forty-one patients were included in the final analysis. The mean (SD) age was 68.4 (10.4) years, and 31 patients (91%) were male. Cognitive recovery was observed in 23/41 (56.1%) of patients at 3 h after extubation, 26/41 (63.4%) at postoperative Day 1, 31/41 (75.6%) at postoperative Day 3, and 30/41 (73.2%) at postoperative Day 7. While physiological, emotive, and activities of daily living domains showed progressive improvement over time, nociceptive recovery remained incomplete throughout follow-up and was primarily driven by persistent pain rather than nausea.

Cognitive recovery after total arch replacement improved gradually during the early postoperative period but remained incomplete in a substantial proportion of patients at postoperative Day 7. These findings highlight the heterogeneous nature of postoperative cognitive recovery and support the importance of serial cognitive assessment after complex aortic surgery.