&lt;p&gt;Physical Performance and Risk of Postoperative Delirium in Older Adults Undergoing Aortic Valve Replacement&lt;/p&gt;

Rao, Aarti; Shi, Sandra; Afilalo, Jonathan; Popma, Jeffrey J.; Khabbaz, Kamal R.; Laham, Roger J.; Guibone, Kimberly; Marcantonio, Edward R.; Kim, Dae Hyun

doi:10.2147/cia.s257079

Cited by 9 publications

(8 citation statements)

References 42 publications

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“…Reasons for exclusion were no diagnosis by physician or research personnel (428 studies), no characterization of predisposing or precipitating factors (338 studies), retrospective study design (86 studies), not diagnosed by reference standard (108 studies), no multivariable model (43 studies), delirium assessment not conducted in person (25 studies), not cohort or case-control design (20 studies), sample included less than 50 patients (12 studies), abstract only (18 studies), cohort previously reported (3 studies), and pediatric population (1 studies). Ultimately, 315 studies…”

Section: Resultsmentioning

confidence: 99%

“…Studies were conducted in 40 different countries, with the plurality in the United States (86 studies [27.3%]), followed by China (48 studies [15.2%]) and the Netherlands (24 studies [7.6%]). Most studies were prospective cohort studies (296 studies…”

Section: Resultsmentioning

confidence: 99%

“…A list of included studies with number of participants and NOS score is included in eTable in Supplement 1). There were 138 studies (43.8%) that excluded participants due to a language barrier (participants were excluded if they did not speak the same language that delirium assessors used).…”

Section: Resultsmentioning

confidence: 99%

“…Delirium was measured by research personnel in 171 studies (54.3%), a combination of research personnel and physicians in 5 studies (1.6%), and a physician in 139 studies …”

Section: Resultsmentioning

confidence: 99%

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Predisposing and Precipitating Factors Associated With Delirium

et al. 2023

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ImportanceDespite discrete etiologies leading to delirium, it is treated as a common end point in hospital and in clinical trials, and delirium research may be hampered by the attempt to treat all instances of delirium similarly, leaving delirium management as an unmet need. An individualized approach based on unique patterns of delirium pathophysiology, as reflected in predisposing factors and precipitants, may be necessary, but there exists no accepted method of grouping delirium into distinct etiologic subgroups.ObjectiveTo conduct a systematic review to identify potential predisposing and precipitating factors associated with delirium in adult patients agnostic to setting.Evidence ReviewA literature search was performed of PubMed, Embase, Web of Science, and PsycINFO from database inception to December 2021 using search Medical Subject Headings (MeSH) terms consciousness disorders, confusion, causality, and disease susceptibility, with constraints of cohort or case-control studies. Two reviewers selected studies that met the following criteria for inclusion: published in English, prospective cohort or case-control study, at least 50 participants, delirium assessment in person by a physician or trained research personnel using a reference standard, and results including a multivariable model to identify independent factors associated with delirium.FindingsA total of 315 studies were included with a mean (SD) Newcastle-Ottawa Scale score of 8.3 (0.8) out of 9. Across 101 144 patients (50 006 [50.0%] male and 49 766 [49.1%] female patients) represented (24 015 with delirium), studies reported 33 predisposing and 112 precipitating factors associated with delirium. There was a diversity of factors associated with delirium, with substantial physiological heterogeneity.Conclusions and RelevanceIn this systematic review, a comprehensive list of potential predisposing and precipitating factors associated with delirium was found across all clinical settings. These findings may be used to inform more precise study of delirium’s heterogeneous pathophysiology and treatment.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

“…Delirium was measured by research personnel in 171 studies (54.3%), a combination of research personnel and physicians in 5 studies (1.6%), and a physician in 139 studies …”

Section: Resultsmentioning

confidence: 99%

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Predisposing and Precipitating Factors Associated With Delirium

et al. 2023

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“…Nonetheless, to make preoperative screening more clinically applicable there is a need for further studies to find other tests or test combinations that increase the preoperative predictive accuracy for postoperative delirium. 39 It is possible that tests with higher sensitivity for mild cognitive impairment are needed. For example, Montreal Cognitive Assessment (MoCA) in combination with Trial Making Test B may be more suitable for detection of mild cognitive impairment.…”

Section: Discussionmentioning

confidence: 99%

Prediction of Postoperative Delirium After Cardiac Surgery with A Quick Test of Cognitive Speed, Mini-Mental State Examination and Hospital Anxiety and Depression Scale

Segernäs

Skoog

Andersson

et al. 2022

CIA

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Purpose To evaluate if preoperative assessment with A Quick Test of Cognitive Speed (AQT) could increase the accuracy of predicting delirium after cardiac surgery compared to Mini-Mental State Examination (MMSE), and examine if a composite of variables, including cognitive function and depressive symptoms, could be useful to predict delirium. Patients and Methods Cardiac surgery was performed in 218 patients (mean age 72 years). Preoperative evaluation involved AQT, MMSE and Hospital Anxiety And Depression Scale (HADS). Postoperative delirium was assessed using Nursing Delirium Screening Scale (Nu-DESC) and Confusion Assessment Method-ICU (CAM-ICU). Logistic regression was performed to detect predictors of postoperative delirium and receiver operator characteristic curves (ROC) with area under the curve (AUC) to determine the accuracy. Results Postoperative delirium occurred in 47 patients (22%) who had lower MMSE scores (median (range), 27 (19–30) vs 28 (20–30), p =0.009) and slower AQT (median (range), 76 (48–181) vs 70 (40–182) seconds, p =0.030) than patients without delirium. Predictive power measured as AUC (95% CI) was 0.605 (0.51–0.70) for AQT and 0.623 (0.53–0.72) for MMSE. Logistic regression (OR, 95% CI) showed MMSE <27 points (2.72, 1.27–5.86), AQT >70 sec (2.26, 1.03–4.95), HADS-D >4 points (2.60, 1.21–5.58) and longer cardiopulmonary bypass-time (1.007, 1.002–1.013) to be associated with postoperative delirium. Combining these parameters yielded an AUC of 0.736 (0.65–0.82). Conclusion The ability of predicting delirium using AQT was similar to MMSE, and only slightly higher by combining AQT and MMSE. Adding HADS-D and cardiopulmonary bypass-time to MMSE and AQT increased the predictive power to a borderline acceptable discriminatory value. Preoperative cognitive tests and screening for depressive symptoms may help identify patients at risk of postoperative delirium. Yet, there is still a need to establish useful preoperative tests.

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