Gender Differences and Postoperative Delirium in Adult Patients Undergoing Cardiac Valve Surgery

Abstract

Background: Postoperative delirium (POD) is common in patients following cardiac surgery. According to studies on non-cardiac surgery, males suffered from higher incidence of POD. However, there is no report about effect of gender differences on POD occurrence in cardiac surgery patients. The aim of this study was to investigate the effect of gender differences on POD occurrence in adult patients after cardiac valve surgery.Methods: This is a retrospective case-control study. We recorded the clinical data in adult patients who underwent elective cardiac valve surgery from May 2019 to October 2020. POD was assessed by the Confusion Assessment Method for Intensive Care Unit. Univariate analysis was used to screen the potential risk factors. Collinearity analysis was conducted to detect overlapping predictor variables on the outcomes. A multivariate logistic regression with odds ratio (OR) and 95% confidence interval (CI) was used to identify the independent risk factors. The Hosmer-Lemeshow test was performed to show the good calibration of the logistic regression model.Results: In total, we recorded the perioperative data in 431 adult patients, including 212 males and 219 females. Sixty patients suffered from POD, including 39 males and 21 females. Twenty-one perioperative variables were selected, and 11 were screened by univariate analysis. We did not detect the severe collinearity among the 11 variables. Male gender was identified as a significant risk factor in POD occurrence in patients undergoing cardiac surgery (Adjusted OR: 2.213, 95% CI: 1.049–4.670, P = 0.037). The Hosmer-Lemeshow test demonstrated good calibration of the logistic regression model (χ2 = 7.238, P = 0.511). Besides, compared with females, the relationship of male and delirium subtypes was as follows: (1) hyperactive: adjusted OR: 3.384, 95% CI: 1.335–8.580, P = 0.010; (2) hypoactive: adjusted OR: 0.509, 95% CI: 0.147–1.766, P = 0.287. A Stratification analysis by age demonstrated that the males showed higher POD incidence in patients aged younger than 60 years (adjusted OR: 4.384, 95% CI: 1.318–14.586, P = 0.016).Conclusions: Male gender is an important risk factor in POD occurrence in patients following cardiac surgery. Furthermore, the incidence of hyperactive delirium is higher in males. Besides, the male patients aged younger than 60 years are at high risk of POD. We should pay more attention to the male patients to prevent their POD occurrence.

Sex-Specific Risk Factors for Short- and Long-Term Outcomes after Surgery in Patients with Infective Endocarditis

“…Men tended to develop a delirium more often than women, as we already observed at aortic surgery [ 26 ]. This is in line with the findings of Wang et al that male gender is an important predictor for postoperative delirium following cardiac surgery [ 27 ]. Moreover, red blood cell transfusion, which was more frequent in our male patients postoperatively, was shown to be an important initiating risk factor for delirium after cardiac surgery in a review by Koster et al [ 28 ], as well as the association with prolonged postoperative stay in our male patients [ 29 ].…”

The Impact of Perioperative and Predisposing Risk Factors on the Development of Postoperative Delirium and a Possible Gender Difference

“…In terms of gender distribution, it appears that males (38%) in the total cohort were substantially more likely to have been delirious than females (21%). These findings are supported by the 2021 retrospective study of cardiac surgery patients by Wang et al [ 15 ]. There, male gender was confirmed as a significant risk factor for delirium development.…”

“…Less discussed were gender differences in relation to POD development. One study showed, based on adjusted regression results, that male sex is an important risk factor for delirium development during cardiac valve surgery [ 15 ].…”

Clinical Predictors and Outcomes Associated with Postoperative Delirium Following Infrainguinal Bypass Surgery

“…27 Our finding may be a result of differences in patient demographics between LEB and hip fracture patients, differences in screening practices, and inclusion of hypoactive delirium in our study, which is more common in female patients. 28 Using the 11-item mFI score, frailty was not an independent predictor of POD. On bivariate analysis, frailty was associated with POD; after accounting for age, this association did not persist.…”