Incidence, Risk Factors and Impact on Long-Term Outcome of Postoperative Delirium After Transcatheter Aortic Valve Replacement

Abstract

Background: The aim of the present study was to analyze incidence, risk factors, and association with long-term outcome of postoperative delirium (POD) after transcatheter aortic valve replacement (TAVR).Methods: Six hundred and sixty one consecutive patients undergoing TAVR were prospectively enrolled from January 2016 to December 2017. POD was assessed regularly during ICU-stay using the CAM-ICU test.Results: The incidence of POD was 10.0% (n = 66). Patients developing POD were predominantly male (65%), had higher EuroSCORE II (5.4% vs. 3.9%; P = 0.041) and were more often considered frail (70% vs. 26%; P < 0.001). POD was associated with more peri-procedural complications including vascular complications (19.7 vs. 9.4; P = 0.017), bleeding (12.1 vs. 5.4%; P = 0.0495); stroke (4.5 vs. 0.7%; P = 0.025), respiratory failure requiring ventilation (16.7% vs. 1.8%; P < 0.001), and pneumonia (34.8% vs. 7.1%; P < 0.001). Consequently, patients with POD had significantly longer ICU- (7.9 vs. 3.2 days P < 0.001) and hospital-stay (14.9 vs. 9.0 days; P < 0.001), and higher in-hospital mortality (6.1 vs. 2.1%; P = 0.017). Logistic regression analysis identified male sex (odds ratio (OR) 2.2 [95% confidence interval (CI) 1.2–4.0); P = 0.012], atrial fibrillation [OR 3.0 (CI 1.6–5.6); P < 0.001], frailty [OR 4.3 (CI 2.4–7.9); P < 0.001], pneumonia [OR 4.4 (CI 2.3–8.7); P < 0.001], stroke [OR 7.0 (CI 1.2–41.6); P = 0.031], vascular complication [OR 2.9 (CI 1.3–6.3); P = 0.007], and general anesthesia [OR 2.0 (CI 1.0–3.7); P = 0.039] as independent predictors of POD. On Cox proportional hazard analysis POD emerged as a significant predictor of 2-year mortality [HR 1.89 (CI 1.06–3.36); P = 0.030].Conclusion: POD is a frequent finding after TAVR and is significantly associated with reduced 2-year survival. Predictors of delirium include not only peri-procedural parameters like stroke, pneumonia, vascular complications and general anesthesia but also baseline characteristics as male sex, atrial fibrillation and frailty.

Profiling Delirium Progression in Elderly Patients via Continuous-Time Markov Multi-State Transition Models

“…In literature, delirium outcome has been mainly addressed in prevalence [ 15 , 16 , 17 ] and incidence studies [ 18 ]. These approaches are useful to investigate the magnitude of the problem in a specific ward and moment.…”

Investigation of Risk Factors for Postoperative Delirium after Transcatheter Aortic Valve Implantation: A Retrospective Study

“…POD is a frequently observed complication after cardiovascular surgery that develops acutely, is associated with a decline in consciousness, attention, and cognition, and is closely related to prolonged ICU stays, longer hospital stays, and increased mortality. Both patient-specific factors (e.g., older age, male sex, cognitive dysfunction, and frailty) and intervening factors (surgery and associated complications) have been reported as contributing factors [ 5 , 13 , 14 , 15 , 16 , 17 ].…”

“…However, postoperative delirium (POD), which has shown a considerably lower incidence after TAVI (10–44%) than after open-heart surgery (>50%) [ 2 , 3 , 4 , 5 , 6 ], remains a cause of poor outcomes, including longer intensive care unit (ICU) stays [ 5 ], hospital stays [ 7 ], and increased mortality [ 5 , 8 ]. Many risk factors for POD have been reported because of patient background factors, such as advanced age, male sex [ 5 ], preoperative cognitive function [ 9 ], sedatives and other medications [ 10 ], and multiple organ damage [ 9 , 11 ]. However, few factors are available for intervention.…”

Clinical literature on postoperative delirium and neurocognitive disorders: a historical systematic review

“…Indeed, postoperative delirium (POD) and postoperative cognitive dysfunction (POCD) are correlated with most of the memory impairments and executive and cognitive dysfunctions observed after surgery, both in the short and long term [1]. The associations between PND and worst surgical outcomes are nowadays clear, especially in case of unexpected intensive care unit (ICU) admission, prolonged ICU length of stay, patient hospitalization, and delayed surgical recovery [2][3][4]. PND is thus a major focus of current research in the field of perioperative medicine [5].…”