DOI: https://doi.org/10.14710/jai.v0i0.79631

Lower Preoperative and Postoperative Hemoglobin Levels in Patients with Postoperative Cognitive Dysfunction Compared to Those Without Postoperative Cognitive Dysfunction Following Heart Valve Replacement

1Anaesthesiology Department and Intensive Therapy, Faculty of Medicine, Universitas Diponegoro, Semarang, Indonesia

2Neurosurgery Department, Faculty of Medicine, Universitas Diponegoro/Kariadi General Hospital, Semarang, Indonesia

3Anaesthesiology Department and Intensive Therapy, National Cardiovascular Center, Harapan Kita Hospital, Jakarta, Indonesia

4 Neurology Department, Faculty of Medicine, Universitas Diponegoro/Kariadi General Hospital, Semarang, Indonesia

5 Faculty of Medicine, Public Health, and Nursing, Gadjah Mada University, Yogyakarta, Indonesia

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Received: 11 Nov 2025; Revised: 3 Feb 2026; Accepted: 25 Feb 2026; Available online: 25 Feb 2026.
Open Access Copyright 2026 JAI (Jurnal Anestesiologi Indonesia)
Creative Commons License This work is licensed under a Creative Commons Attribution 4.0 International License.

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Abstract

Background: Postoperative cognitive dysfunction (POCD) is a prevalent complication that occurs after surgery, impacting cognitive function. Cognitive performance may be hindered by anemia, as it reduces the delivery of oxygen to the brain and leads to tissue hypoxia, affecting metabolism and ultimately diminishing cognitive function.

Objective: The objective of this study is to examine the potential correlation between hemoglobin levels and the occurrence of POCD in individuals undergoing heart valve replacement surgery.

Methods: This retrospective cohort study included all individuals aged 20 years and above who underwent heart valve replacement surgery from July to December 2021. Hemoglobin levels were assessed both before and after the surgical procedure, and cognitive function was evaluated using the Indonesian-adapted Montreal Cognitive Assessment (MOCA-INA) on the third day after the operation. Statistical analysis involved the use of either Student's t-test or the Mann–Whitney nonparametric test.

Results: A total of 70 participants were included in the study from July to December 2021. The majority of the participants were female (57.1%), and a significant proportion were below 60 years old (81.4%). The average preoperative hemoglobin levels were higher (13.30 g/dL) than the average postoperative hemoglobin levels (10.78 g/dL). In terms of cognitive function, 61.4% of participants experienced postoperative cognitive dysfunction (POCD), with a higher mean MoCA-INA score before surgery (28.41) than after surgery (22.37), along with a delta Hb of -0.27. Furthermore, postoperative hemoglobin levels were significantly lower in POCD patients than preoperatively (p = 0.003).

Conclusion: The occurrence of postoperative cognitive dysfunction (POCD) was linked to the hemoglobin levels after heart valve replacement.

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Keywords: disorders of cognition; dysfunction in cognitive processes; levels of haemoglobin; replacement of heart valves; surgical procedure on the heart

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Section: Original Articles
Language : EN
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  1. Glumac S, Kardum G, Karanovic N. Postoperative cognitive decline after cardiac surgery: A narrative review of current knowledge in 2019. Med Sci Monit. 2019;25:3262–3270
  2. Nurcahyo WI, Arifin A, Primatika AD, Muttaqin Z, Boom CE, Harahap MS, et al. An association between C-reactive protein levels and the occurrence of cognitive dysfunction after heart valve replacement. Vasc Health Risk Manag. 2021;17:713–720
  3. Panda N, Mathew P, Narayana Y, Kohli A, Gandhi K, Kumar P. Early Post Operative Cognitive Dysfunction (POCD) in middle aged hypertensive patients: A pilot study. J Neuroanaesth Crit Care. 2014;1(3):198–203
  4. Feinkohl I, Winterer G, Pischon T. Hypertension and Risk of Post-Operative Cognitive Dysfunction (POCD): A Systematic Review and Meta-Analysis. Clin Pract Epidemiol Ment Heal. 2017;13:27–42
  5. Norkiene I, Ringaitiene D, Kuzminskaite V, Šipylaite J. Incidence and risk factors of early delirium after cardiac surgery. Biomed Res Int. 2013;2013:323491
  6. Wang W, Wang Y, Wu H, Lei L, Xu S, Shen X, et al. Postoperative cognitive dysfunction: Current developments in mechanism and prevention. Med Sci Monit. 2014;20:1908–1912
  7. Soenarto R, Arbi A. Effect of oxygen content on postoperative cognitive dysfunction in patients undergoing open-heart surgery. J Nat Sci Biol Med. 2019;10:S7-10
  8. Vide S, Gambús PL. Tools to screen and measure cognitive impairment after surgery and anesthesia. Press Medicale. 2018;47(4P2):e65–e72
  9. Riedel B, Browne K, Silbert B. Cerebral protection: Inflammation, endothelial dysfunction, and postoperative cognitive dysfunction. Curr Opin Anaesthesiol. 2014;27(1):89–97
  10. Sun Y, Feng H, Zou T, Hou M, Jin Y, Gu C, et al. Assessment of risk factors for postoperative cognitive dysfunction after coronary artery bypass surgery: a single-center retrospective cohort study. Biosci Rep. 2021;41(2):BSR20190719
  11. Arbi A. Association Between Postoperative Haemoglobin, Arterial Oxygen Partial Pressure, Arterial Oxygen Saturation, Venous Oxygen Saturation with Postoperative Cognitive Dysfunction after Open Heart Surgery in Cipto Mangunkusumo Hospital. Jakarta: University of Indonesia; 2017
  12. Kulier A, Levin J, Moser R, Rumpold-Seitlinger G, Tudor IC, Snyder-Ramos SA, et al. Impact of preoperative anemia on outcome in patients undergoing coronary artery bypass graft surgery. Circulation. 2007;116:471–9
  13. Karkouti K, Wijeysundera DN, Beattie WS. Risk associated with preoperative anemia in cardiac surgery : A multicenter cohort study. Circulation. 2008;117(4):478–484
  14. Payne RS, Goldbart A, Gozal D, Schurr A. Effect of intermittent hypoxia on long-term potentiation in rat hippocampal slices. Brain Res. 2004;1029:195–9
  15. Nemoto EM, Yonas H, Kuwabara H, Pindzola RR, Sashin D, Meltzer CC, et al. Identification of hemodynamic compromise by cerebrovascular reserve and oxygen extraction fraction in occlusive vascular disease. J Cereb Blood Flow Metab. 2004;24(10):1081–9
  16. Li M, Ratcliffe SJ, Knoll F, Wu J, Ances B, Mardini W, et al. Aging: Impact upon local cerebral oxygenation and blood flow with acute isovolemic hemodilution. J Neurosurg Anesthesiol. 2006;18(2):125–31
  17. Li M, Bertout JA, Ratcliffe SJ, Eckenhoff MF, Simon MC, Floyd TF. Acute anemia elicits cognitive dysfunction and evidence of cerebral cellular hypoxia in older rats with systemic hypertension. Anesthesiology. 2010;113(4):845–858
  18. van Asselen M, Kessels RPC, Neggers SFW, Kappelle LJ, Frijns CJM, Postma A. Brain areas involved in spatial working memory. Neuropsychologia. 2006;44:1185–94
  19. Oldham MA, Vachon J, Yuh D, Lee HB. Cognitive Outcomes After Heart Valve Surgery: A Systematic Review and Meta-Analysis. J Am Geriatr Soc. 2018;66(12):2327–2334
  20. You Z, Chen L, Xu H, Huang Y, Wu J, Wu J. Influence of Anemia on Postoperative Cognitive Function in Patients Undergo Hysteromyoma Surgery. Front Mol Biosci. 2021;8:786070
  21. Price CC, Garvan CW, Monk TG. Type and severity of cognitive decline in older adults after cardiac surgery. Anesthesiology. 2008;108:8–17
  22. Pappa M, Theodosiadis N, Tsounis A, Sarafis P. Pathogenesis and treatment of post-operative cognitive dysfunction. Electron physician. 2017;9(2):3592–3597
  23. Deiner S, Silverstein JH. Postoperative delirium and cognitive dysfunction. Br J Anaesth. 2009;103(Suppl 1):i41‑6
  24. Bekker A, Lee C, de Santi S, Pirraglia E, Zaslavsky A, Farber S, et al. Does mild cognitive impairment increase the risk of developing postoperative cognitive dysfunction? Am J Surg. 2010;199(6):782–788
  25. Husein N, Lumempouw S, Ramli Y. Validity and realibility study of Montreal Cognitive Assessment Indonesia version (MoCA-Ina) for screening cognitive function disorder. Neurona. 2010;27(4):15–22
  26. Roussel J, Khalil S. Postoperative Cognitive Dysfunction: An Updated Review. J Neurol Neurophysiol. 2015;6:2
  27. Shayan S, Okocha O, Srdanovic N, Balmert L, Grafman J, Madhan AS, et al. Preoperative Anemia and Risk for Perioperative Neurocognitive Dysfunction in Cardiac Surgery Patients: A Retrospective Analysis. J Cardiothorac Vasc Anesth. 2022;36(4):1056–63
  28. Czyż-Szypenbejl K, Mędrzycka-Dąbrowska W, Kwiecień-Jaguś K, Lewandowska K. The occurrence of postoperative cognitive dysfunction (POCD) – Systematic review. Psychiatr Pol. 2019;53(1):145–160
  29. Xu T, Bo L, Wang J, Zhao Z, Xu Z, Deng X, et al. Risk factors for early postoperative cognitive dysfunction after non-coronary bypass surgery in Chinese population. J Cardiothorac Surg. 2013;8(1):1

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