Outcomes Associated With Postoperative Delirium After Cardiac Surgery

Abstract

Background Delirium after surgery is a common condition that leads to poor outcomes. Few studies have examined the effect of postoperative delirium on outcomes after cardiac surgery. Objectives To assess the relationship between delirium after cardiac surgery and the following outcomes: length of stay after surgery, prevalence of falls, discharge to a nursing facility, discharge to home with home health services, and use of inpatient physical therapy. Methods Electronic medical records of 656 cardiac surgery patients were reviewed retrospectively. Results Postoperative delirium occurred in 161 patients (24.5%). Patients with postoperative delirium had significantly longer stays (P < .001) and greater prevalence of falls (P < .001) than did patients without delirium. Patients with delirium also had a significantly greater likelihood for discharge to a nursing facility (P < .001) and need for home health services if discharged to home (P < .001) and a significantly higher need for inpatient physical therapy (P < .001). Compared with patients without postoperative delirium, patients who had this complication were more likely to have received zolpidem and benzodiazepines postoperatively and to have a history of arrhythmias, renal disease, and congestive heart failure. Conclusions Patients who have delirium after cardiac surgery have poorer outcomes than do similar patients without this complication. Development and implementation of an extensive care plan to address postoperative delirium is necessary for cardiac surgery patients who are at risk for or have delirium after the surgery.

The quality of life of patients developed delirium after coronary artery bypass grafting is determined by cognitive function after discharge: A cross‐sectional study

“…It was characterized by a disturbance in attention that develops over a short period and tends to fluctuate during the course of the day (Sachdev et al, ). Some studies indicated that patients who developed POD after cardiac surgery was associated with increased mortality, worse functional outcomes, and reduced QoL (Crocker et al, ; Koster, Hensens, Schuurmans, & van der Palen, ; Mangusan, Hooper, Denslow, & Travis, ). In a study of 656 patients who underwent cardiac surgery, Mangusan et al () found that patients with POD had significantly longer hospital stay, greater prevalence of falls, and greater likelihood for discharge to a nursing facility than patients without delirium.…”

“…Some studies indicated that patients who developed POD after cardiac surgery was associated with increased mortality, worse functional outcomes, and reduced QoL (Crocker et al, ; Koster, Hensens, Schuurmans, & van der Palen, ; Mangusan, Hooper, Denslow, & Travis, ). In a study of 656 patients who underwent cardiac surgery, Mangusan et al () found that patients with POD had significantly longer hospital stay, greater prevalence of falls, and greater likelihood for discharge to a nursing facility than patients without delirium. A prospective study showed that delirium after cardiac procedures was associated with increased mortality, reduced cognitive function, and reduced QoL, but the relationships among POD, declined cognitive function, and QoL after discharge was not tested (Koster et al, ).…”

The Effect of Music Intervention on CAM Scores of Hospitalized Older Adults Experiencing Delirium

“…Though the rationale for the use of this additional resource was not explored in this study, one of the possible reasons is safety concerns, more specifically, the increased risk for falls. This would validate the study by Mangusan, Hooper, Denslow, and Travis (2015), which found that cardiac patients who experienced delirium had statistically higher prevalence of falls. DeCrane, Culp, and Wakefield (2012) reported similar findings in the long-term care settings where patients with delirium were more likely to experience a fall.…”

Awake craniotomy

“…It was recently shown in general surgery patients that sedative premedication did not improve patient satisfaction or preoperative anxiety [29]. The use of benzodiazepines is also associated with a higher occurrence of postoperative delirium [30]. The use of other agents like clonidine, promethazine and dexmedetomidine as preoperative sedatives is also common and at least partially understandable considering the pharmacological profiles.…”