Cardiac Autonomic Dysfunction and Peri-Operative Outcomes Among Elective Neurosurgical Patients: Secondary Analysis of a Prospective Observational Study.

Cardiac autonomic dysfunction (CAD), as assessed by an ANSiscope™, is highly prevalent among the Indian neurosurgical population. Cranial lesions affecting the central autonomic neuroregulatory circuit may predispose to CAD, influencing the circulatory and hemodynamic response to stressful anesthetic and neurosurgical events. CAD has been implicated in the causation of perioperative adverse cardiac events (PACE) during cardiac procedures. Its relevance in neurosurgery has remained a grey area. We conducted this single-center prospective observational study to explore the impact of the preoperative CAD (using an ANSiscope™-derived indices of heart rate variability) on the perioperative hemodynamic profile and other clinical outcomes of 400 consenting adult patients undergoing elective neurosurgery at our tertiary care neurosciences center. The primary aim of this secondary analysis of our previous study was to evaluate the impact of the pre-operative autonomic nervous system (ANS) function on the perioperative adverse cardiac events (PACE) composite score. Our secondary objectives were to explore the effect of CAD on PACE, in-hospital mortality, length of hospital stay, and Glasgow Coma Scale (GCS) score at discharge. We performed statistical analysis using R software. A P value of <0.05 was statistically significant. The median PACE composite score was similar across groups (P = 0.449), with 1 (0-2) in normal and 1 (0-1) across the three CAD groups (P = 0.449). The variance of the intraoperative hemodynamic parameters and early postoperative PACE (P = 0.484) were similar across the groups. Mortality, hospital stay duration, and discharge GCS score were similar across groups. CAD, as assessed by an ANSiscope™, did not impact any of the study's outcomes.