Delirium and depression in cardiac surgery: A comprehensive review of risk factors, pathophysiology, and management

Abstract

Background Mental health and wellbeing continue to gain more attention as they are inextricably associated with clinical outcomes, particularly quality of life. Many medical ailments and major surgeries affect patients’ mental health, including depression and delirium. Aims The objective of this manuscript was to comprehensively review and critically examine the literature pertaining to cardiac surgery, depression, and delirium. Methods This is a narrative review article. We performed our search analysis by using the following key words: “Cardiac Surgery”, “Depression”, “Delirium”, “Clinical outcomes”, and “Mental Health”. Search analysis was done on MedLine PubMed, accessing indexed peer‐reviewed publications. Results Cardiac Surgery is a life‐altering intervention indicated to improve morbidity and mortality in patients with cardiovascular diseases. Psychiatric conditions before and after cardiac surgery worsen patient prognosis and increase mortality rate. Specifically, preoperative depression increases postoperative depression and is associated with impaired functional status, slow physical recovery, and an increased readmission rate. Discussion Although the exact pathophysiology between depression and cardiovascular disease (CVD) is unknown, several pathways have been implicated. Unmanaged depression can also lead to other psychological conditions such as delirium. Like depression, the exact association between delirium and CVD is not well understood, but believed to be multifactorial. Conclusion Herein, we provide a comprehensive review of the links between depression, delirium, and cardiovascular surgery. We critically examine the current data that pertains to the pathophysiology of these debilitating mental health issues in the context of cardiac surgery. Finally, we summarize the various treatment options available for managing depression and delirium in the cardiac surgery patient population.

Melatonin and Its Analogs for Prevention of Post-cardiac Surgery Delirium: A Systematic Review and Meta-Analysis

“…The exact mechanism of post-cardiac surgery delirium is uncertain and may be of multifactorial origin ( 50 ). But Previous studies have suggested that old age ( 51 ) and inflammation ( 52 ) are independent risk factors for POD.…”

“…In patients undergoing cardiac surgery, the incidence of delirium is strongly associated with the duration of mechanical ventilation, ICU stay, and hospitalization. POD can prolong the mechanical ventilation time, length of ICU stay, length of hospitalization after cardiac surgery ( 50 , 63 , 64 ), and duration of mechanical ventilation, length of ICU stay, and length of hospitalization serve as precipitating factors for POD ( 65 , 66 ). However, our meta-analysis did not show a significant difference in the aforementioned clinical outcomes based on the premise that melatonin can significantly reduce the incidence of POD.…”

Pre-Habilitation of Cardiac Surgical Patients, Part 2: Frailty, Malnutrition, Respiratory disease, Alcohol/Smoking cessation and Depression

“…69 Female sex, lower levels of education, and lack of social support are predictors of depression. 69 Pre-existing depression can be associated with increased mortality and morbidity after cardiac surgery. 70 Increased cardiac events, prolonged recovery, impaired quality of life after recovery, and increased readmissions have been correlated with depression.…”

Controversies in enhanced recovery after cardiac surgery

“…An aging population will continue to contribute to a greater prevalence of heart disease in an older and increasingly frail cardiac patient population, who are themselves vulnerable to delirium. The perioperative team should view the occurrence of postoperative delirium as a quality indicator for health care delivery because it is common, associated with iatrogenesis and integrally linked to processes of care (Fatehi Hassanabad et al 2021 ). The contemporary cardiac team should seek to incorporate routine risk identification during the preoperative evaluation and consider opportunities to optimize vulnerable patients while they await surgery (Enomoto et al 2021 ).…”