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

BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.