Postoperative Cognitive Impairment Short-term cognitive changes occur in some patients after on-pump CABG.873 875 The precise incidence depends on the timing of the postoperative assessment and the choice of criteria for cognitive decline.876,877 Similar short-term cogni- tive changes also are noted in elderly patients receiving general anesthesia for noncardiac surgery.878 880 Risk factors for short-term postoperative cognitive decline include preex- isting risk factors for cerebrovascular disease,881 preexisting central nervous system disease,882 and preexisting cognitive impairment.75 Up to 30% of candidates for CABG have been shown to have cognitive impairment before surgery.75 A few studies have reported a lower incidence of short-term cogni- tive decline after off-pump CABG than on-pump CABG,883 but most studies have shown no difference in cognitive outcomes between them.884 Studies with appropriate compar- ison groups have demonstrated that most patients do not suffer cognitive decline after CABG.885,886 For those who do, the postoperative cognitive changes are generally mild, and for most patients, they resolve within 3 months of surgery.887 Long-term cognitive decline after CABG has been re- ported,888,889 but other studies have shown that a similar degree of late cognitive decline occurs in comparison groups of demographically similar patients with CAD but without surgery, suggesting that the late decline is not related to the use of CPB.890 An RCT comparing late cognitive outcomes after on-pump and off-pump CABG has reported no differ- ence between them.891 See Online Data Supplement 34 for additional data on the role of perioperative cognitive impairment. Infection: Recommendations Class I 1. Preoperative antibiotics should be administered to all patients to reduce the risk of postoperative infection.892 897 (Level of Evidence: A) 2. A first- or second-generation cephalosporin is rec- ommended for prophylaxis in patients without methicillin-resistant Staphylococcus aureus coloniza- tion.897 905 (Level of Evidence: A) 3. 