Association between postoperative delirium and heart rate variability in the intensive care unit and readmissions and mortality in elderly patients with cardiovascular surgery

Tsukakoshi, Daichi; Yamamoto, Shuhei; Nojima, Ippei; Sato, Masa‐aki; Furuhashi, Keisuke; Takeda, Shuhei; Oguchi, Natsuko; Kasuga, Sho; Ichimura, Hajime; Wada, Yuko; Seto, Takashi; Horiuchi, Hiroki

doi:10.1007/s00380-022-02173-1

Cited by 6 publications

(6 citation statements)

References 45 publications

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“…This study found that coronary heart disease, AF, changes in the ST-T segment, and low HRV were independent risk factors for postoperative ICU transfer, which was consistent with the results of previous studies [ 7 , 8 , 11 ]. Some abnormal ECG results can predict the difficulty in managing perioperative anesthesia, and patients need to be transferred to the ICU for close monitoring after surgery.…”

Section: Discussionsupporting

confidence: 93%

“…This study found that low HRV was an independent risk factor for PND. In addition, patients with lower HRV displayed a higher ICU transfer rate, longer hospital stay, and greater impact on the perioperative outcome than patients with normal HRV, which aligns with the results of studies conducted outside China [ 7 , 8 , 11 ]. HRV is the fluctuation of the time interval between adjacent R waves on ECG [ 12 ].…”

Section: Discussionsupporting

confidence: 83%

“…the results of previous studies [7,8,11]. Some abnormal ECG results can predict the difficulty in managing perioperative anesthesia, and patients need to be transferred to the ICU for close monitoring after surgery.…”

Section: Plos Onementioning

confidence: 97%

“…There is a correlation between HRV and cognition [ 6 ]. In addition, abnormal perioperative HRV in patients undergoing orthopedic surgery is related to postoperative delirium, postoperative transfer to the intensive care unit (ICU), and extended hospital stay [ 7 , 8 ]. However, research on this topic is lacking.…”

Section: Introductionmentioning

confidence: 99%

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Correlation between heart rate variability and perioperative neurocognitive disorders in patients undergoing non-cardiac surgery: A retrospective cohort study

Liu,

Wan,

Wang

et al. 2024

PLoS ONE

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Objective With the improvement of medical level, the number of elderly patients is increasing, and the postoperative outcome of the patients cannot be ignored. However, there have been no studies on the relationship between preoperative heart rate variability (HRV) and Perioperative Neurocognitive Disorders (PND). The purpose of this study was to explore the correlation between (HRV) and (PND), postoperative intensive care unit (ICU), and hospital stay in patients undergoing non-cardiac surgery. Method This retrospective analysis included 687 inpatients who underwent 24-hour dynamic electrocardiogram examination in our six departments from January 2021 to January 2022. Patients were divided into two groups based on heart rate variability (HRV): high and low. Possible risk factors of perioperative outcomes were screened using univariate analysis, and risk factors were included in multivariate logistic regression to screen for independent risk factors. The subgroup analysis was carried out to evaluate the robustness of the results. The nomogram of PND multi-factor logistic prediction model was constructed. The receiver operating characteristic (ROC) curve was drawn, and the calibration curve was drawn by bootstrap resampling 1000 times for internal verification to evaluate the prediction ability of nomogram. Result A total of 687 eligible patients were included. The incidence of low HRV was 36.7% and the incidence of PND was 7.6%. The incidence of PND in the low HRV group was higher than that in the high HRV group (11.8% vs 5.2%), the postoperative ICU transfer rate was higher (15.9% than 9.3%P = 0.009), and the hospital stay was longer [15 (11, 19) vs (13), 0.015]. The multivariable logistic regression analysis showed that after adjusting for other factors, decreased low HRV was identified as an independent risk factor for the occurrence of PND (Adjusted Odds Ratio = 2.095; 95% Confidence Interval: 1.160–3.784; P = 0.014) and postoperative ICU admission (Adjusted Odds Ratio = 1.925; 95% Confidence Interval: 1.128–3.286; P = 0.016). This study drew a nomogram column chart for a multivariate logistic regression model, incorporating age and HRV. The calibration curve shows that the predicted value of the model for the occurrence of cardio-cerebrovascular events is in good agreement with the actual observed value, with C-index of 0.696 (95% CI: 0.626 ~ 0.766). Subgroup analysis showed that low HRV was an independent risk factor for PND in patients with gastrointestinal surgery and ASA Ⅲ, aged ≥ 65 years. Conclusion In patients undergoing non-cardiac surgery, the low HRV was an independent risk factor for PND and postoperative transfer to the ICU, and the hospitalization time of patients with low HRV was prolonged. Through establishing a risk prediction model for the occurrence of PND, high-risk patients can be identified during the perioperative period for early intervention.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 83%

Section: Plos Onementioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Correlation between heart rate variability and perioperative neurocognitive disorders in patients undergoing non-cardiac surgery: A retrospective cohort study

Liu,

Wan,

Wang

et al. 2024

PLoS ONE

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“…Studies have shown a correlation between POD and unfavorable consequences, including heightened mortality rates, extended hospital stays, and elevated medical costs. Additionally, POD may contribute to lasting and more substantial declines in cognitive functions and daily life activities [9][10][11][12][13] .…”

Section: Development Of An Individualized Model For Predicting Postop...mentioning

confidence: 99%

Development of an individualized model for predicting postoperative delirium in elderly patients with hepatocellular carcinoma

Yan,

Lin,

Zheng

et al. 2024

Sci Rep

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Postoperative delirium (POD) is a common complication in older patients with hepatocellular carcinoma (HCC) that adversely impacts clinical outcomes. We aimed to evaluate the risk factors for POD and to construct a predictive nomogram. Data for a total of 1481 older patients (training set: n=1109; validation set: n=372) who received liver resection for HCC were retrospectively retrieved from two prospective databases. The receiver operating characteristic (ROC) curve, calibration plot, and decision curve analysis (DCA) were used to evaluate the performance. The rate of POD was 13.3% (148/1109) in the training set and 16.4% (61/372) in the validation set. Multivariate analysis of the training set revealed that factors including age, history of cerebrovascular disease, American Society of Anesthesiologists (ASA) classification, albumin level, and surgical approach had significant effects on POD. The area under the ROC curves (AUC) for the nomogram, incorporating the aforementioned predictors, was 0.798 (95% CI 0.752–0.843) and 0.808 (95% CI 0.754–0.861) for the training and validation sets, respectively. The calibration curves of both sets showed a degree of agreement between the nomogram and the actual probability. DCA demonstrated that the newly established nomogram was highly effective for clinical decision-making. We developed and validated a nomogram with high sensitivity to assist clinicians in estimating the individual risk of POD in older patients with HCC.

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A comprehensive assessment tool of acute-phase rehabilitation is associated with clinical outcomes in patients after cardiovascular surgery

Ogura,

Hamazaki,

Kamiya

et al. 2024

Heart Vessels

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Association between postoperative delirium and heart rate variability in the intensive care unit and readmissions and mortality in elderly patients with cardiovascular surgery

Cited by 6 publications

References 45 publications

Correlation between heart rate variability and perioperative neurocognitive disorders in patients undergoing non-cardiac surgery: A retrospective cohort study

Correlation between heart rate variability and perioperative neurocognitive disorders in patients undergoing non-cardiac surgery: A retrospective cohort study

Development of an individualized model for predicting postoperative delirium in elderly patients with hepatocellular carcinoma

A comprehensive assessment tool of acute-phase rehabilitation is associated with clinical outcomes in patients after cardiovascular surgery

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