Intraoperative anesthesia care transitions are strongly associated with worse outcomes, with a similar effect size for attendings, residents, and nurse anesthetists.

MACEs and MAPEs occur at similar frequencies and affect survival to a similar degree. All 3 types of postoperative troponin elevation in this analysis were associated, to varying degrees, with increased risk of death and disability.

Background Postoperative delirium is common in patients recovering from cardiac surgery. Tight glucose control has been shown to reduce mortality and morbidity. We therefore sought to determine the effect of tight intraoperative glucose control using a hyper-insulinemic normoglycemic clamp approach on postoperative delirium in patients undergoing cardiac surgery. Methods We enrolled 198 adult patients having cardiac surgery in this randomized, double-blinded single-center trial. Patients were randomly assigned to either tight intraoperative glucose control with a hyperinsulinemic-normoglycemic clamp (target blood glucose: 80–110 mg/dL) or standard therapy (conventional insulin administration with blood glucose target < 150 mg/dL). Delirium was assessed using a comprehensive delirium battery. We considered patients to have experienced postoperative delirium when Confusion Assessment Method testing was positive at any assessment. A positive Confusion Assessment Method test was defined by the presence of features 1 (acute onset and fluctuating course) and 2 (inattention), and either 3 (disorganized thinking) or 4 (altered consciousness). Results Patients randomized to tight glucose control were more likely to be diagnosed as being delirious than those assigned to routine glucose control (26/93 vs. 15/105; Relative Risk (RR), 95% CI: 1.89, 1.06–3.37; P = 0.03), after adjusting for preoperative usage of calcium channel blocker and American Society of Anesthesiologist (ASA) physical status. Delirium severity, among patients with delirium, was comparable with each glucose management strategy. Conclusions Intraoperative hyperinsulinemic-normoglycemia augments the risk of delirium after cardiac surgery, but not its severity.