Association between preoperative on‐site CCU visits and postoperative delirium in patients undergoing cardiac surgery: A retrospective cohort study

Abstract

BackgroundPostoperative delirium (POD) is a common complication after cardiac surgery (CS), with symptoms like attention disorders and even delays patients' recovery.AimsTo evaluate the impact of preoperative on‐site visits in the cardiac care unit (CCU) on POD after CS.Study DesignPatients admitted to the CCU with extracorporeal CS were included in the visiting or non‐visiting group according to whether they were on visiting week. The visiting group received a preoperative visit from a nurse‐led multidisciplinary visiting team (including CCU nurses and physicians) 1 week before surgery in addition to standard care. The non‐visiting group received standard care like unstructured information from the CS team and anesthesiologists and so on. The Confusion Assessment Method for the ICU (CAM‐ICU) and the Intensive Care Delirium Screening Checklist (ICDSC) were used to evaluate the POD severity. The incidence, occurrence and duration of POD, as well as the CCU length of stay, postoperative mechanical ventilation duration and length of hospital stay were compared between the two groups.ResultsA total of 735 participants (369 in the visited group and 366 in the unvisited group) were included in this study. Preoperative on‐site visits were associated with a decreased POD incidence (odds ratio [OR]: 0.524, 95% CI: 0.336–0.817), an improved POD severity (OR: 0.578, 95% CI: 0.359–0.932) and a shortening POD duration (OR: 0.972, 95% CI: 0.951–0.994). There was a significant difference between the visiting and non‐visiting groups in the mechanical ventilation duration (OR: 0.987, 95% CI: 0.978–0.996).ConclusionsPreoperative on‐site visits are associated with a reduction in the incidence, duration, and severity of POD, as well as the mechanical ventilation duration of patients.Relevance to Clinical PracticeThis study found that preoperative on‐site visits were associated with the onset, duration, severity and duration of mechanical ventilation of POD. Although many factors influence the occurrence of POD, a multidisciplinary visiting team led by a nurse (including CCU nurses and physicians) can provide early nursing interventions through preoperative visits, better obtain postoperative cooperation from patients, establish a good nurse–patient relationship and provide better health services to patients. In a realistic CCU setting, nurses and physicians can act as educators, assessing patients before surgery, enhancing preoperative education, improving patient familiarity with the CCU environment and teaching sign language communication skills when patients are mechanically ventilated. These findings can therefore provide the basis for effective clinical care to prevent postoperative POD.

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“…Lee and Roh 4 investigated the knowledge, barriers and training of nurses caring for patients with delirium in the Republic of Korea; Xu et al 5 and Wu et al 6 examined the risk factors of delirium in paediatric and adult intensive care unit (ICU) patients respectively; whereas Mortensen et al 7 and Castillejos et al 8 explored the experiences and the psychological symptoms of ICU survivors who had experienced delirium or difficult sedation 1 year after being discharged. Other papers report on clinical trials, observational studies or reviews investigating the potential impact of preoperative cardiac care unit visits, 9 eye masks and ear plugs, 10 sensory stimulation, 11 early sedation with dexmedetomidine, 12 non-pharmacological interventions 13 and improved sleep quality 14 on the prevention of delirium in critically ill patients.…”