Incidence of and Risk Factors for Delirium After Cardiac Surgery at a Quaternary Care Center: A Retrospective Cohort Study

Tse, Lurdes; Schwarz, Stephan; Bowering, John; Moore, Randell L.; Barr, Alasdair M.

doi:10.1053/j.jvca.2015.06.018

Cited by 47 publications

(43 citation statements)

References 32 publications

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“…The overall incidence of delirium was 19.8% which corresponds to previous studies (23, 24). The potential effect of CPB on postoperative delirium has yet to be directly studied, but several studies have investigated an association between CPB exposure and POCD which may be linked to postoperative delirium (13, 15–17).…”

Section: Discussionsupporting

confidence: 86%

Risk factors for delirium after cardiac surgery: a historical cohort study outlining the influence of cardiopulmonary bypass

O’Neal

Billings

Liu

et al. 2017

Can J Anesth/J Can Anesth

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Purpose Cardiopulmonary bypass (CPB) induces a significant inflammatory response that may increase the risk for delirium. We hypothesized that exposure to CPB during coronary artery bypass grafting surgery would correlate with an increased risk of delirium and would be associated with several other outcomes. Methods We reviewed clinical data from two databases at our medical center, the Cardiac Surgery Perioperative Outcomes Database and the Society of Thoracic Surgeons Database. Patients undergoing elective coronary artery bypass grafting surgery (on-pump and off-pump) from November 1, 2009 to September 30, 2015 were included in the study. Delirium was defined as any positive CAM-ICU exam following surgery during the ICU course. We performed logistic regression to isolate the association between CPB exposure and delirium adjusted for predetermined risk factors and potential confounders. Results During the study period, a total of 2,280 patients underwent elective coronary artery bypass grafting surgery with 384 patients (16.9%) exposed to CPB. Delirium was diagnosed in 451 patients (19.8%). CPB exposure demonstrated a significant independent association with delirium (P = 0.002). The adjusted relative risk (RR) of delirium was 2.18 (95% CI, 1.39 to 3.07; P = 0.002) among patients exposed to CPB for 142 minutes (90th percentile of CPB duration), compared to a RR of only 1.51 (95% CI, 0.92 to 2.29; P = 0.10) for those on CPB for 54 minutes (10th percentile). Conclusions CPB use and duration of use were associated with an increased risk of delirium in patients undergoing coronary artery bypass grafting surgery.

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Section: Discussionsupporting

confidence: 86%

Risk factors for delirium after cardiac surgery: a historical cohort study outlining the influence of cardiopulmonary bypass

O’Neal

Billings

Liu

et al. 2017

Can J Anesth/J Can Anesth

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“…3 Another study that included on-pump and off-pump CABG surgeries, valve surgery, and also patients who underwent transcatheter aortic valve implantation cardiac surgery found an association between β-blocker use and delirium (OR 1.7, 95% CI 1.1 to 2.6, p = 0.01). 11 Within our cohort, no association between patients taking β blockers and the incidence of delirium was evident. Our primary analysis showed an association with decreased duration of delirium; however, the secondary analysis was not consistent with this finding.…”

Section: Discussionmentioning

confidence: 54%

“…11,12 In a study on patients who underwent vascular surgery, Katznelson et al found an increased incidence of delirium in patients taking β blockers (26.5% vs 17.4%, p = 0.03). 3 Another study that included on-pump and off-pump CABG surgeries, valve surgery, and also patients who underwent transcatheter aortic valve implantation cardiac surgery found an association between β-blocker use and delirium (OR 1.7, 95% CI 1.1 to 2.6, p = 0.01).…”

Section: Discussionmentioning

confidence: 99%

Effect of Preoperative Beta-Blocker Use on Outcomes Following Cardiac Surgery

O’Neal

Billings

Liu

et al. 2017

The American Journal of Cardiology

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Recent studies suggest that the use of preoperative β blockers in cardiac surgery may not provide improved mortality rates and may even contribute to negative clinical outcomes. We therefore assessed the role of β blockers on several outcomes after cardiac surgery (delirium, acute kidney injury [AKI], stroke, atrial fibrillation (AF), mortality, and hospital length of stay) in 4,076 patients who underwent elective coronary artery bypass grafting, coronary artery bypass grafting + valve, or valve cardiac surgery from November 1, 2009, to September 30, 2015, at Vanderbilt Medical Center. Clinical data from 2 prospectively collected datasets at our institution were reviewed: the Cardiac Surgery Perioperative Outcomes Database and the Society of Thoracic Surgeons Database. Preoperative β-blocker use was defined by Society of Thoracic Surgeons guidelines as patients receiving a β blocker within 24 hours preceding surgery. Of the included patients, 2,648 (65.0%) were administered a β blocker within 24 hours before surgery. Adjusting for possible confounders, preoperative β-blocker use was associated with increased odds of AKI stage 2 (odds ratio 1.96, 95% confidence interval 1.19 to 3.24, p <0.01). There was no evidence that β-blocker use had an independent association with postoperative delirium, AKI stages 1 and 3, stroke, AF, mortality, or prolonged length of stay. A secondary propensity score analysis did not show a marginal association between β-blocker use and any outcome. In conclusion, we did not find significant evidence that preoperative β-blocker use was associated with postoperative delirium, AF, AKI, stroke, or mortality.

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“…In a prospective study of 300 elderly patients undergoing hip joint replacement, Silbert et al found that patients with pre-operative CI had a significantly increased incidence of post-operative cognitive decline at 7 days, 3 months, and 1 year post-operatively (15). Similarly, in a retrospective study of 679 patients undergoing cardiac surgery, Tse et al showed an association with CI and increased rate of postoperative delirium (16).…”

Section: Discussionmentioning

confidence: 98%

185 The Prevalence of Undiagnosed Pre-Surgical Cognitive Impairment and Its Post-Surgical Clinical Impact in Elderly Patients Undergoing Surgery for Adult Spinal Deformity

Adogwa¹,

Elsamadicy²,

Lydon³

et al. 2017

Neurosurgery

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Background: Pre-existing cognitive impairment (CI) is emerging as a predictor of poor post-operative outcomes in elderly patients. Little is known about impaired preoperative cognition and outcomes after elective spine surgery in this patient population. The purpose of this study was to assess the prevalence of neuro CI in elderly patients undergoing deformity surgery and its impact on postoperative outcomes.Methods: Elderly subjects undergoing elective spinal surgery for correction of adult degenerative scoliosis were enrolled in this study. Pre-operative baseline cognition was assessed using the Saint Louis Mental Status (SLUMS) test. SLUMS consists of 11 questions, which can give a maximum of 30 points. Mild CI was defined as a SLUMS score between 21-26 points, while severe CI was defined as a SLUMS score of ≤20 points. Normal cognition was defined as a SLUMS score of ≥27 points. Complication rates, duration of hospital stay, and 30-day readmission rates were compared between patients with and without baseline CI.Results: Eighty-two subjects were included in this study, with mean age of 73.26±6.08 years. Fiftyseven patients (70%) had impaired cognition at baseline. The impaired cognition group had the following outcomes: increased incidence of one or more postoperative complications (39% vs. 20%), higher incidence of delirium (20% vs. 8%), and higher rate of discharge institutionalization at skilled nursing or acute rehab facilities (54% vs. 30%). The length of hospital stay and 30-day hospital readmission rates were similar between both cohorts (5.33 vs. 5.48 days and 12.28% vs. 12%, respectively).Conclusions: CI is highly prevalent in elderly patients undergoing surgery for adult degenerative scoliosis. Impaired cognition before surgery was associated with higher rates of post-operative delirium, complications, and discharge institutionalization. CI assessments should be considered in the pre-operative evaluations of elderly patients prior to surgery.

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Incidence of and Risk Factors for Delirium After Cardiac Surgery at a Quaternary Care Center: A Retrospective Cohort Study

Cited by 47 publications

References 32 publications

Risk factors for delirium after cardiac surgery: a historical cohort study outlining the influence of cardiopulmonary bypass

Risk factors for delirium after cardiac surgery: a historical cohort study outlining the influence of cardiopulmonary bypass

Effect of Preoperative Beta-Blocker Use on Outcomes Following Cardiac Surgery

185 The Prevalence of Undiagnosed Pre-Surgical Cognitive Impairment and Its Post-Surgical Clinical Impact in Elderly Patients Undergoing Surgery for Adult Spinal Deformity

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