Detailed Insight Into the Impact of Postoperative Neuropsychiatric Complications on Mortality in a Cohort of Cardiac Surgery Subjects: A 23,000-Patient-Year Analysis

Krzych, Łukasz J.; Wybraniec, Maciej T.; Krupka-Matuszczyk, I.; Skrzypek, Michał; Bolkowska, Anna; Wilczyński, Mirosław; Bochenek, Andrzej

doi:10.1053/j.jvca.2013.05.005

Cited by 42 publications

(24 citation statements)

References 35 publications

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“… 29 Short- and long-term mortality were shown to independently correspond with baseline plasma glucose in a cohort of cardiac surgery patients. 30 An abnormal serum glucose level was one of the causative factors in the development of postoperative psychiatric disorders in patients undergoing general thoracic surgery. 31 A study showed that the initial, mean, and maximal intraoperative blood glucose concentrations were significantly higher in patients experiencing complications including death after cardiac surgery.…”

Section: Discussionmentioning

confidence: 99%

Prevalence and risk factors of postoperative delirium in elderly hip fracture patients

et al. 2016

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ObjectiveTo explore the risk factors associated with postoperative delirium (PD) in elderly patients following total hip arthroplasty (THA) for hip fracture.MethodsThis prospective study enrolled elderly patients (≥ 65 years) with hip fractures who underwent THA under general anaesthesia, and who had a complete set of postoperative observations. Detailed medical history and perioperative characteristics were recorded. During the postoperative period, patients were assessed twice daily for PD using the Confusion Assessment Method.ResultsA total of 572 patients were eligible for inclusion in the study. Of these, 120 patients (21.0%) were diagnosed with PD and 452 patients (79.0%) did not experience PD. Multivariate stepwise logistic regression analyses showed that older age, a history of stroke, lower albumin, higher blood glucose, higher total bilirubin, higher C-reactive protein, longer surgery duration and higher volume of red blood cell transfusions were independent risk factors for PD.ConclusionsCorrecting the modifiable risk factors might help prevent PD. Strategies might include nutritional support, tight blood glucose control, improvement of liver function, preoperative infection control and minimizing surgical injury or blood loss.

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Section: Discussionmentioning

confidence: 99%

Prevalence and risk factors of postoperative delirium in elderly hip fracture patients

et al. 2016

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“…Although diagnostics and surgical techniques have significantly improved, the post-operative neurological morbidity rate in AAD patients remains high (10). POD is associated with several negative outcomes, including elevated morbidity and mortality, prolonged ICU stay, and extra medical expenses (11)(12)(13).…”

Section: Introductionmentioning

confidence: 99%

Prevalence, Predictors, and Early Outcomes of Post-operative Delirium in Patients With Type A Aortic Dissection During Intensive Care Unit Stay

et al. 2020

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The aim of this study was to investigate the prevalence and explore the predictors and early outcomes of post-operative delirium (POD) in patients with type A aortic dissection (AAD) during intensive care unit (ICU) stays. Methods: We retrospectively reviewed the records of 301 patients with AAD who underwent surgical treatment in our institution from January 2017 to December 2018. Results: Delirium developed in 73 patients (24.25%) during the ICU stay. Patients with lower estimated glomerular filtration rates [odds ratio (OR) 0.84, 95% CI 0.74-0.94, p = 0.003], post-operative midazolam use (OR 2.37, 95% CI 1.33-4.23, p = 0.004), and post-operative morphine use (OR 1.87, 95% CI 1.07-3.29, p = 0.029) were more susceptible to developing POD. Patients who developed POD had a longer ICU stay (11.52 vs. 7.22 days, p < 0.001) and hospital stay (23.99 vs. 18.91, p = 0.007) with higher hospitalization costs (48.82 vs. 37.66 thousand dollars, p < 0.001) than those without POD. The in-hospital mortality rate was higher in the delirium group, but the difference was not significant (6.85 vs. 4.82%, p = 0.502). Conclusions: The incidence of POD in patients with AAD was high and was associated with renal dysfunction and the use of midazolam and morphine. POD was associated with poor early outcomes, suggesting the importance of early screening, such as for renal dysfunction, and prevention by using sedation scales to minimize the use of midazolam and morphine in these patients.

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“…3,4 Delirium can significantly increase the incidence of adverse events and even the chance of a 30-day death after surgery. [5][6][7] Sleep disorder (SPD) is a common issue among adults given their accelerated social rhythm, frequent change of life style, and factors that have close relationships with psychological illness. 8,9 Some studies have found that both preoperative obstructive sleep apnoea (OSA) through sleep-disordered breathing and postoperative poor sleep quality exhibit significant correlations with PD.…”

Section: Introductionmentioning

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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Detailed Insight Into the Impact of Postoperative Neuropsychiatric Complications on Mortality in a Cohort of Cardiac Surgery Subjects: A 23,000-Patient-Year Analysis

Cited by 42 publications

References 35 publications

Prevalence and risk factors of postoperative delirium in elderly hip fracture patients

Prevalence and risk factors of postoperative delirium in elderly hip fracture patients

Prevalence, Predictors, and Early Outcomes of Post-operative Delirium in Patients With Type A Aortic Dissection During Intensive Care Unit Stay

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

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