Postoperative delirium and quality of life after transcatheter and surgical aortic valve replacement: A prospective observational study

Hoogma, Danny Feike; Venmans, Elisabeth; Tmimi, Layth Al; Tournoy, Jos; Verbrugghe, Peter; Jacobs, Steven; Fieuws, Steffen; Milisen, Koen; Adriaenssens, Tom; Dubois, Christophe; Rex, Steffen

doi:10.1016/j.jtcvs.2021.11.023

Cited by 9 publications

(5 citation statements)

References 45 publications

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“…The valve and anesthesia comparisons were published separately in two journals, 12,13 and both were included as a complete study in the meta‐analysis. The majority of the included studies were observational (33 prospective studies, 14–46 28 retrospective studies, 47–74 and 4 studies with unknown nature 75–78 ), with only four RCTs 12,13,79–81 . The number of included patients varied widely, ranging from 25 to 170,521 per study.…”

Section: Resultsmentioning

confidence: 99%

Postoperative delirium after transcatheter aortic valve replacement: An updated systematic review and meta‐analysis

Chu

Han

et al. 2022

J American Geriatrics Society

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Aims To perform an updated systematic review and meta‐analysis of postoperative delirium (POD) after transcatheter aortic valve replacement (TAVR). Methods We conducted a systematic literature search of PubMed, Embase, and Cochrane Library databases from the time of the first human TAVR procedure in 2002 until December 24, 2021, which was supplemented by manual searches of bibliographies. Data were collected on incidence rates, risk factors, and/or associated mortality of POD after TAVR. Pooled analyses were conducted using random effects models to yield mean differences, odds ratios, hazard ratios, and risk ratios, with 95% confidence intervals. Results A total of 70 articles (69 studies) comprising 413,389 patients were included. The study heterogeneity was substantial. The pooled mean incidence of POD after TAVR in all included studies was 9.8% (95% CI: 8.7%–11.0%), whereas that in studies using validated tools to assess for delirium at least once a day for at least 2 consecutive days after TAVR was 20.7% (95% CI: 17.8%–23.7%). According to the level of evidence and results of meta‐analysis, independent preoperative risk factors with a high level of evidence included increased age, male sex, prior stroke or transient ischemic attack, atrial fibrillation/flutter, weight loss, electrolyte abnormality, and impaired Instrumental Activities of Daily Living; intraoperative risk factors included non‐transfemoral access and general anesthesia; and acute kidney injury was a postoperative risk factor. POD after TAVR was associated with significantly increased mortality (pooled unadjusted RR: 2.20, 95% CI: 1.79–2.71; pooled adjusted RR: 1.62, 95% CI: 1.25–2.10), particularly long‐term mortality (pooled unadjusted HR: 2.84, 95% CI: 1.91–4.23; pooled adjusted HR: 1.88, 95% CI: 1.30–2.73). Conclusions POD after TAVR is common and is associated with an increased risk of mortality. Accurate identification of risk factors for POD after TAVR and implementation of preventive measures are critical to improve prognosis.

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Section: Resultsmentioning

confidence: 99%

Postoperative delirium after transcatheter aortic valve replacement: An updated systematic review and meta‐analysis

Chu

Han

et al. 2022

J American Geriatrics Society

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“…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).…”

Section: Data Extractionmentioning

confidence: 99%

“…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.…”

Section: Introductionmentioning

confidence: 99%

“…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 .…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2023

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AimsThe aims of the study were to determine the relationship between preoperative geriatric nutritional risk index (GNRI) and the occurrence of postoperative delirium (POD) in elderly patients after cardiac surgery and to evaluate the additive value of GNRI for predicting POD.MethodsThe data were extracted from the Multiparameter Intelligent Monitoring in Intensive Care (MIMIC‐IV) database. Patients who underwent cardiac surgery and were aged 65 or older were included. The relationship between preoperative GNRI and POD was investigated using logistic regression. We determined the added predictive value of preoperative GNRI for POD by measuring the changes in the area under the receiver operating characteristic curve (AUC) and calculating the net reclassification improvement (NRI) and integrated discrimination improvement (IDI).ResultsA total of 4286 patients were included in the study, and 659 (16.1%) developed POD. Patients with POD had significantly lower GNRI scores than patients without POD (median 111.1 vs. 113.4, p < 0.001). Malnourished patients (GNRI ≤ 98) had a significantly higher risk of POD (odds ratio, 1.83, 90% CI, 1.42–2.34, p < 0.001) than those without malnutrition (GNRI > 98). This correlation remains after adjusting for confounding variables. The addition of GNRI to the multivariable models slightly but not significantly increases the AUCs (all p > 0.05). Incorporating GNRI increases NRIs in some models and IDIs in all models (all p < 0.05).ConclusionsOur results showed a negative association between preoperative GNRI and POD in elderly patients undergoing cardiac surgery. The addition of GNRI to POD prediction models may improve their predictive accuracy. However, these findings were based on a single‐center cohort and will need to be validated in future studies involving multiple centers.

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“…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 ].…”

Section: Introductionmentioning

confidence: 99%

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

Ogata

Kobayashi

Yamauchi

2022

JCM

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Transcatheter aortic valve implantation (TAVI) is an effective treatment for severe aortic stenosis (AS); however, postoperative delirium (POD) can worsen patient outcomes. This study aimed to examine the risk factors for POD after TAVI, including possible intervening factors. We included 87 patients (mean age: 83) who underwent TAVI between May 2014 and September 2018. POD was defined by the presence or absence of delirium on ICU admission, assessed using the Confusion Assessment Method for the ICU. Factors that showed significant differences in the univariate analysis were analyzed using a multiple logistic regression analysis. In total, 31 patients (36%) had POD after ICU admission, and 56 (64%) did not. The preoperative frailty score and aortic valve opening area (AVA) were significant risk factors for POD. The multivariate analysis also showed that both factors were independent risk factors for POD (area under the receiver operating characteristic curve: 0.805). There were no significant differences in the number of ICU days. However, postoperative hospitalization was significantly longer in the POD group (19 (17–31) days vs. 16 (13–22) days; p = 0.002). POD was associated with a narrow AVA and frailty; this suggests that frailty prevention interventions according to the AVA may be important.

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Postoperative delirium and quality of life after transcatheter and surgical aortic valve replacement: A prospective observational study

Cited by 9 publications

References 45 publications

Postoperative delirium after transcatheter aortic valve replacement: An updated systematic review and meta‐analysis

Postoperative delirium after transcatheter aortic valve replacement: An updated systematic review and meta‐analysis

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

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

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