Association of electroencephalogram epileptiform discharges during cardiac surgery with postoperative delirium: An observational study

Abstract

BackgroundDelirium is a frequent and serious complication following cardiac surgery involving cardiopulmonary bypass (CPB). Electroencephalography reflects the electrical activity of the cerebral cortex. The impact of electroencephalographic epileptiform discharges during cardiac surgery on postoperative delirium remains unclear. This study was designed to investigate the relationship between intraoperative epileptiform discharges and postoperative delirium in patients undergoing cardiac surgery.MethodsA total of 76 patients who underwent cardiac surgery under CPB were included. The baseline cognitive status was measured before surgery. Electroencephalograms were monitored continuously from entry into the operating room to the end of surgery. The presence of delirium was assessed through the Confusion Assessment Method or the Confusion Assessment Method for the Intensive Care Unit on the first 3 days after surgery. Univariate and multivariate logistic regression analyses were performed to evaluate the association between epileptiform discharges and delirium.ResultsDelirium occurred in 31% of patients and epileptiform discharges were present in 26% of patients in the study. Patients with delirium had a higher incidence of epileptiform discharges (52.63% vs. 13.95%, P < 0.001) and longer durations of anesthesia and CPB (P = 0.023 and P = 0.015, respectively). In addition, patients with delirium had a longer length of hospital stay and a higher incidence of postoperative complications. Multivariate logistic regression analysis showed that age and epileptiform discharges were significantly associated with the incidence of postoperative delirium [odds ratio, 4.75 (1.26–17.92), P = 0.022; 5.00 (1.34–18.74), P = 0.017, respectively].ConclusionsPostoperative delirium is significantly related to the occurrence of epileptiform discharges during cardiac surgery.

Intraoperative electroencephalogram patterns as predictors of postoperative delirium in older patients: a systematic review and meta-analysis

“…After careful reading of the full-text articles, 32 studies were excluded ( Supplementary Table S3 ). Ultimately, this systematic review included 19 studies published between 2015 and 2023 (Soehle et al, 2015 ; Fritz et al, 2016 ; Hesse et al, 2019 ; Momeni et al, 2019 ; Pedemonte et al, 2020 ; Jung et al, 2021 ; Koch et al, 2021 , 2023 ; Lele et al, 2022 ; Li et al, 2022 ; Lutz et al, 2022 ; Röhr et al, 2022 ; Windmann et al, 2022 ; Baron Shahaf et al, 2023 ; Dragovic et al, 2023 ; Khalifa et al, 2023 ; Kinoshita et al, 2023 ; Reese et al, 2023 ; Ostertag et al, 2024 ). Additionally, 10 of these articles were included in the meta-analysis (Soehle et al, 2015 ; Hesse et al, 2019 ; Pedemonte et al, 2020 ; Jung et al, 2021 ; Koch et al, 2021 , 2023 ; Lele et al, 2022 ; Lutz et al, 2022 ; Röhr et al, 2022 ; Ostertag et al, 2024 ).…”