Postoperative Cardiovascular Surgery Delirium

Abstract

Purpose The aims of this study were to examine interrater agreement of delirium between clinical nurses and a clinical nurse specialist, determine delirium subtype prevalence, and examine associated patient, procedure, and hospital factors. Design A descriptive cross-sectional design and a convenience sample of nurses and patients on progressive care units were used in this study. Methods Clinical nurse specialist data were collected on a case report form, and clinician and patient data were obtained from electronic databases. Interrater agreement of delirium prevalence was assessed by κ statistic, and logistic regression models were used to determine patient factors associated with delirium. Results Of 216 patients, 23 had delirium; clinical nurses identified fewer cases than the clinical nurse specialist: 1.8% versus 10.7%; κ agreement, 0.27 (0.06, 0.49). By delirium subtype, hypoactive delirium was more frequent (n = 10). Factors associated with delirium were history of cerebrovascular disease (odds ratio [95% confidence interval], 2.8 [1.01–7.7]; P = .044), history of mitral valve disease (odds ratio [95% confidence interval], 0.31 [0.09–0.90]; P = .041), and longer perfusion time (odds ratio [95% confidence interval], 1.7 [1.1–2.7]; P = .016). One factor was associated with hypoactive delirium, longer perfusion time (odds ratio [95% confidence interval], 2.2 [1.3–4.2]; P = .008). Conclusions Because clinician–clinical nurse specialist delirium agreement was low and hypoactive delirium was common, clinical interventions are needed.

Incidence and risk factors for postoperative delirium after head and neck cancer surgery: an updated meta-analysis

“…The subtype of POD may be influenced by factors related to specific surgical patient populations. For example, hypoactive-type POD, characterized by lethargy, apathy, and reduced motor activity, occurs more frequently after cardiac and hip fracture surgery [ 10 , 11 ], while hyperactive-type POD, characterized by agitation, restlessness, and insomnia, is common after head and neck cancer surgery [ 12 ]. Recently, several meta-analyses demonstrated that some predisposing risk factors (ageing, low albumin, diabetes, history of delirium, preoperative depression, preoperative functional dependence, mild cognitive impairment, and carotid artery stenosis) and precipitating risk factors (time of mechanical ventilation, surgery delay > 48 h, and intensive care unit stay time) could increase the incidence of POD in patients after cardiac and orthopedic surgery [ 13 , 14 ].…”