Lower Preoperative Verbal Memory Performance Is Associated with Delirium after Coronary Artery Bypass Graft Surgery: A Prospective Cohort Study

Abstract

Objective Cognitive impairment constitutes one of the major risk factors of delirium after coronary artery bypass graft (CABG) surgery; however, it is unclear whether only patients with global cognitive decline are at increased risk for delirium or if individuals with preserved global cognitive functions but impairments in specific cognitive domains are also more vulnerable to developing delirium. Thus, this study aimed to analyze the neurocognitive status of patients scheduled for CABG surgery with the use of an advanced computerized cognitive battery (CNS Vital Signs) and to investigate possible associations between impaired performance in selective cognitive areas and the risk of postoperative delirium development. Methods The study enrolled 127 participants with a median age of 67 years (IQR: 63–71). Postoperative delirium developed in 32 (25%) patients. Before surgery, the patients were screened for global cognitive impairment with the use of the Mini-Mental State Examination Test, and the individuals were asked to perform the CNS Vital Signs battery to investigate 12 specific cognitive domains. The Confusion Assessment Method and the Memorial Delirium Assessment Scale were used to screen for a diagnosis of delirium postoperatively. Results In multivariate models, a lower score of verbal memory-assessed preoperatively was independently associated with the risk of postoperative delirium development. Other independent predictors of delirium included more advanced age, gender female, depression, postoperative pyrexia, and the presence of extracorporeal circulation. Conclusions As decreased verbal memory constitutes an independent risk factor for postoperative delirium, a verbal memory test may be a useful predictor of postoperative delirium development.

Predicting Postoperative Delirium in Older Patients: a multicenter retrospective cohort study

“…However, the absence of preoperative neuropsychological tests reduced the performance of POD prediction in the context of models solely relying on preoperative features (Figure 2-C), which is critical given that surgical and postoperative management could be optimized. Preoperative models with neuropsychological tests effectively predicted POD before surgery substantiating previous observations 13,28,51 . This could be attributed to preoperative neuropsychological tests revealing subtle cognitive deficits, despite less than 2% of dementia diagnoses before surgery in this study cohort (eTable 1).…”

“…Nonbinary categorical features, including location, SMI, types of anesthesia, and surgery, were one-hot encoded because they had no natural ordinal relationship among their categories, and assigning numerical labels to them could introduce bias or incorrect assumptions in the model. Seventy features were used, divided into preoperative (51) and perioperative (19) categories. Preoperative features encompassed demographic (7), clinical (23), surgical categories (6), and neuropsychological assessments (15).…”

Delirium syndrome in the postoperative period

“…A prospective cohort study [81] Delirium and long-term psychopathology following surgery in older adults [82] CAM-ICU DSM-V ICD- Postoperative delirium is an independent factor influencing the length of stay of elderly patients in th intensive care unit and in hospital [83] A processed electroencephalogram-based brain anesthetic resistance index is associated with postoperative delirium in older adults: a dual center study [84] Independent external validation of a preoperative prediction model for delirium after cardiac surgery: a prospective observational cohort study [85] Lower preoperative verbal memory performance is associated with delirium after coronary artery bypass graft surgery: a prospective cohort study [86] Effect of regional vs. general anesthesia on incidence of postoperative delirium in older patients undergoing hip fracture surgery [ Lower preoperative serum uric acid level may be a risk factor for postoperative delirium in older patients undergoing hip fracture surgery: a matched retrospective case-control study [90] Risk factors and effect of postoperative delirium on adverse surgical outcomes in older adults after elective abdominal cancer surgery in Taiwan [91] High ASA physical status and low serum uric acid to creatinine ratio are independent risk factors for postoperative delirium among older adults undergoing urinary calculi surgery [92] W wybranej do analizy literaturze najliczniejszą grupę badaną tworzyło 10 755 (36,6%) chorych po operacjach kardiochirurgicznych, a odsetek występowania majaczenia pooperacyjnego dotyczył 2043 chorych. Pozostałe prace dotyczyły odpowiednio 7812 (26,6%) chorych po operacjach ortopedycznych, 5227 (18%) chorych po operacjach brzusznych, 689 (2,3%) chorych po operacjach torakochirurgicznych, 484 (1,6%) chorych po operacjach naczyniowych, 2678 (9,1%) chorych po operacjach neurochirurgicznych, 1714 (5,8%) chorych po operacjach urologicznych.…”

“…Według polskich badaczy czynnikami predysponującymi do rozwoju POD są: podeszły wiek, objawy depresyjne, zaburzenia funkcjonowania, cukrzyca. Jako czynniki wyzwalające wskazali dłuższy czas krążenia pozaustrojowego i zwiększone pooperacyjne stężenie mieloperoksydazy [20,37,86,89,95]. Przypadki majaczenia występowały również w grupie chorych po operacjach kardiochirurgicznych, u których określono małe ryzyko tego powikłania.…”