Postoperative Delirium in Cardiac Surgery Patients

Järvelä, Kati; Porkkala, Helena; Karlsson, Sari; Martikainen, Tero J; Selander, Tuomas; Bendel, Stepani

doi:10.1053/j.jvca.2017.12.030

Cited by 54 publications

(51 citation statements)

References 29 publications

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“…PD is a common complication for patients following cardiac 30,31 and major non-cardiac surgeries. 32 Previous studies determined several risk factors associated with PD, including advanced age, low education level, preoperative cognitive dysfunction, smoking, cardiac or macrovascular surgery, major non-cardiac surgeries, perioperative use of sedative and analgesic drugs, postoperative imperfect analgesia, among others.…”

Section: Discussionmentioning

confidence: 99%

Effect of Sleep Disorder on Delirium in Post-Cardiac Surgery Patients

Wang

Zhang

Luo

et al. 2020

Can. J. Neurol. Sci.

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Background: Post-cardiac surgery patients exhibit a higher incidence of postoperative delirium (PD) compared to non-cardiac surgery patients. Patients with various cardiac diseases suffer from preoperative sleep disorder (SPD) induced by anxiety, depression, breathing disorder, or other factors. Objective: To examine the effect of sleep disorder on delirium in post-cardiac surgery patients. Methods: We prospectively selected 186 patients undergoing selective cardiac valve surgery. Preoperative sleep quality and cognitive function of all eligible participants were assessed through the Pittsburgh Sleep Quality Index (PSQI) and the Montreal Cognitive Assessment, respectively. The Confusion Assessment Method for Intensive Care Unit was used to assess PD from the first to seventh day postoperatively. Patients were divided into two groups according to the PD diagnosis: (1) No PD group and (2) the PD group. Results: Of 186 eligible patients, 29 (15.6%) were diagnosed with PD. A univariate analysis showed that gender (p = 0.040), age (p = 0.009), SPD (p = 0.008), intraoperative infusion volume (p = 0.034), postoperative intubation time (p = 0.001), and intensive care unit stay time (p = 0.009) were associated with PD. A multivariate logistic regression analysis demonstrated that age (odds ratio (OR): 1.106; p = 0.001) and SPD (OR: 3.223; p = 0.047) were independently associated with PD. A receiver operating characteristic curve demonstrated that preoperative PSQI was predictive of PD (area under curve: 0.706; 95% confidence interval: 0.595–0.816). A binomial logistic regression analysis showed that there was a significant association between preoperative 6 and 21 PSQI scores and PD incidence (p = 0.009). Conclusions: Preoperative SPD was significantly associated with PD and a main predictor of PD.

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Section: Discussionmentioning

confidence: 99%

Effect of Sleep Disorder on Delirium in Post-Cardiac Surgery Patients

Wang

Zhang

Luo

et al. 2020

Can. J. Neurol. Sci.

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“…In literature, POD was diagnosed within the rst seven days or in a longer period (23,24). In our study, there were 8 patients (2.6%) who were diagnosed early (the rst 3 postoperative days).…”

Section: Discussionmentioning

confidence: 55%

Early Diagnosis Of Postoperative Delirium In Patients Who Underwent General Surgery

oluş¹,

Gündüz²,

Arıcı³

2020

Preprint

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Objective: Postoperative delirium (POD) is a common postoperative complication. This study aimed to diagnose POD early primarily in patients who underwent General Surgery. This study also aimed to shorten the duration of hospital stays, prevent re-hospitalization after discharge and decrease the rates of morbidity/mortality through investigating the relationship with the characteristics of the patients/surgery/anesthesia in patients diagnosed with postoperative delirium in an early period. Material and Methods: Data of 303 patients at the age of 18 and above who were operated by General Surgery Clinic between March 2018 and May 2018, who were followed up by the Department of Anesthesiology and Reanimation for preoperative, intraoperative and postoperative periods and who received general anesthesia were included in the study.Patients’ demographic data, occupation, educational status, income level, additional diseases, ASA (American Society of Anesthesia) score, previous surgeries, history of a psychiatric or neurological disease, history of alcohol, cigarette, or drug use, and memory problems were recorded. Mini Mental State Examination (MMSE) was used to identify preoperative mental levels of the patients. Diagnosis of the patient, name, duration and features of the surgery to be performed, whether the surgery was urgent or elective, drugs used, type of catheterization (artery, central, foley or nasogastric), Hb value, intraoperative vital findings, and duration of postoperative discharge were recorded. The diagnosis of POD in patients was evaluated with Confusion Assessment Method (CAM). Results: POD developed in 2-6% (8 patients) of the patients. A significant relationship was recorded between the diagnosis of POD and age and additional diseases (ASA score). Results showed that the risk of delirium decreased as the education levels of the patients increased. A significant relationship was recorded between delirium and only midazolam among anesthetic agents used. A significant relationship was recorded among hypercarbia that developed during the surgery, invasive procedures, prolonged duration of surgery and hospitalizations in Intensive Care Units and Post-Anesthesia Care Units.Conclusion: The rate of POD (2.6%) and risk factors determined for POD within the first three days in our study were in compliance with literature. Diagnosing POD with CAM in an early postoperative period was advantageous. The treatment planning of the patients for POD could be done in the early period. By doing this, increase in mortality, morbidity and cost as a result of missing the diagnosis of POD was prevented.

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“…In contrast, results for other characteristics such as age or surgical risk scores are far more heterogeneous (19). For instance, whereas some studies found a signi cant association between Euroscore results and delirium risk after cardiac surgery, others did not (22,(25)(26)(27). Indeed, determining whether surgical risk scores could also predict a patient's risk of delirium, regardless of cognitive performance, could be very helpful for busy clinicians who might not be familiar with cognitive screening tools.…”

Section: Introductionmentioning

confidence: 99%

Delirium in older patients undergoing aortic valve replacement Incidence, predictors, and cognitive prognosis

Humbert

Büla

Müller

et al. 2020

Preprint

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Background: To determine delirium incidence, predictors, and relationship with cognitive performance at 3-month follow-up in older patients undergoing aortic valve replacement (AVR).Methods: Patients (N=93) aged 70 years and older, undergoing transcatheter (TAVR, N=66) or surgical (SAVR, N=27) aortic valve replacement in an academic medical center were enrolled in this prospective cohort study. Delirium was assessed using the Confusion Assessment Method (CAM) on postoperative days 1, 2, 3, and 7. Data on patients’ socio-demographics, functional status (including instrumental activities of daily living (IADL), and surgical risk scores (including Society of Thoracic Surgeons (STS) risk score), were collected at baseline. Cognitive status was assessed with the Mini-Mental Status Exam (MMSE) and the Clock Drawing Test (CDT) at baseline and 3 months after AVR.Results: Delirium occurred in 21 (22.6%) patients, within the first three postoperative days in 95% (20/21) of the cases. Delirium incidence was lower in TAVR (13/66=20%) than SAVR (8/27=30%) patients, but this difference was not statistically significant (p=.298). Patients with delirium had lower baseline cognitive performance (median MMSE score 27.0±3.0 vs 28.0±3.0, p=.029), lower performance in IADL (7.0 vs 8.0, p=.038), and higher STS risk scores (4.7±2.7 vs 2.9±2.3, p=.020). In multivariate analyses, patients with intermediate (score>3 to ≤8) and high (score>8) STS scores had 4.3 (95%CI 1.2-15.1, p=.025) and 16.5 (95%CI 2.0-138.2, p=.010), respectively, higher odds of incident delirium compared to patients with low (score≤3) STS scores. At 3-month follow-up (N=77), patients with delirium still had lower MMSE score (27.0±8.0 vs 28.0±2.0, p=.007) but this difference did not remain significant once adjusting for baseline MMSE (β-coefficient 1.11, 95%CI [-3.03-0.80], p=.248).Conclusions: Delirium occurred in about one in five older patients undergoing AVR, almost essentially within the first three postoperative days. Beside cognitive performance, STS score could enhance the identification of high-risk older patients to better target preventative interventions.

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Postoperative Delirium in Cardiac Surgery Patients

Cited by 54 publications

References 29 publications

Effect of Sleep Disorder on Delirium in Post-Cardiac Surgery Patients

Effect of Sleep Disorder on Delirium in Post-Cardiac Surgery Patients

Early Diagnosis Of Postoperative Delirium In Patients Who Underwent General Surgery

Delirium in older patients undergoing aortic valve replacement Incidence, predictors, and cognitive prognosis

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