Outcomes of postoperative delirium in patients undergoing cardiac surgery: A systematic review and meta-analysis

Abstract

BackgroundPostoperative delirium (POD) is an acute brain dysfunction that is frequently observed in patients undergoing cardiac surgery. Increasing evidence indicates POD is related to higher mortality among cardiac surgical patients, but the results remain controversial. Moreover, a quantitative evaluation of the influence of POD on hospital days, intensive care unit (ICU) time, and mechanical ventilation (MV) time has not been performed.ObjectiveThis study aimed to evaluate the correlation between POD and outcomes in patients undergoing cardiac surgery by a systematic review and meta-analysis.Materials and methodsA total of 7 electronic databases (Cochrane Library, PubMed, EMBASE, CINAHL Complete, MEDLINE, Wan-fang database, and China National Knowledge Infrastructure) were searched from January 1980 to July 20, 2021, with language restrictions to English and Chinese, to estimate the impact of the POD on outcome in patients who underwent cardiac surgery. The meta-analysis was registered with PROSPERO (Registration: CRD42021228767).ResultsForty-two eligible studies with 19785 patients were identified. 3368 (17.0%) patients were in the delirium group and 16417 (83%) were in the non-delirium group. The meta-analysis showed that compared to patients without POD, patients with POD had 2.77-fold higher mortality (OR = 2.77, 95% CI 1.86–4.11, P < 0.001), 5.70-fold higher MV (>24h) rate (OR = 5.70, 95% CI 2.93–11.09, P < 0.001); and longer MV time (SMD = 0.83, 95% CI 0.57–1.09, P < 0.001), ICU time (SMD = 0.91, 95% CI 0.60–1.22, P < 0.001), hospital days (SMD = 0.62, 95% CI 0.48–0.76, P < 0.001).ConclusionThe synthesized evidence suggests that POD is causally related to the increased risk of mortality, prolonged length of ICU and hospital stay, and a longer duration of MV time. Future research should focus on the interventions for POD, to reduce the incidence.Systematic review registration[www.crd.york.ac.uk/PROSPERO], identifier [CRD42021228767].

Predictive value of the geriatric nutrition risk index for postoperative delirium in elderly patients undergoing cardiac surgery

“…The data were extracted from the MIMIC-IV database using structured query language with PostgreSQL. The following information was extracted: (1) demographic information: age, sex, ethnicity, weight, and height; (2) comorbidities: hypertension, myocardial infarction, congestive heart failure, peripheral vascular disease, cerebrovascular disease, obstructive sleep apnea, diabetes, chronic pulmonary disease, chronic liver disease, and chronic renal disease; (3) lifestyle factor: alcohol abuse; (4) type of surgery: CABG, valve surgery, aortic replacement, as well as a combined cardiac surgery; (5) laboratory findings before surgery and on the first day in the ICU: peripheral white blood cell count, hemoglobin, serum albumin, and serum creatinine; (6) mean values of vital signs on the first day in the ICU: heart rate, mean arterial blood pressure (MAP), percutaneous oxygen saturation (SpO 2 ), and respiratory rate; (7) the Sequential Organ Failure Assessment (SOFA) score on the first day in the ICU; (8) use of benzodiazepines during ICU stay; (9) outcomes: delirium during hospital stay, ICU and hospital stay lengths, and hospital mortality. The data extraction code is accessible on GitHub (https://github.com/MIT-LCP/mimic -iv).…”

“…There is a high incidence of delirium among patients undergoing cardiac surgery, 2,3 with the elderly having the greatest risk 4 . Postoperative delirium (POD) has been shown to prolong hospital stays, negatively affect patient quality of life, increase economic burdens, and cause long‐term cognitive impairments 5–8 . There are preventive measures that can lower the incidence of POD 9–13 .…”

“… 4 Postoperative delirium (POD) has been shown to prolong hospital stays, negatively affect patient quality of life, increase economic burdens, and cause long‐term cognitive impairments. 5 , 6 , 7 , 8 There are preventive measures that can lower the incidence of POD. 9 , 10 , 11 , 12 , 13 Therefore, it is crucial to identify patients at risk for delirium as early as possible and implement these preventative measures.…”

Pharmacological and non-pharmacological interventions to prevent delirium after cardiac surgery: a protocol for a systematic review and meta-analysis

“…Delirium is a frequent complication after cardiac surgery affecting between one-quarter and one-half of all patients. 1 It is a clinical syndrome characterised by a disturbance in attention, awareness and cognition, which usually starts on postoperative days 1–5 and can fluctuate in severity throughout the day. 2 Peak incidence is on the second postoperative day.…”

“…Perioperative risk factors include length of cardiopulmonary bypass (CPB) 3 and type of surgery performed; valve surgery is associated with an increased incidence of delirium compared with coronary artery bypass grafting (CABG) surgery. 4 Experiencing delirium after cardiac surgery is associated with poor outcomes, including over twice the risk of short-term and long-term mortality, 1 decreased functional status 5 and increased risk of long-term cognitive dysfunction. 6 It also adds around $10 000 to the hospital costs per patient.…”