Preoperative Risk Factors and Early Outcomes of Delirium in Valvular Open-Heart Surgery

Abstract

Background Compared with coronary artery bypass grafting surgery, data regarding postoperative delirium are scant in valvular open-heart surgery. Therefore, the goal of this retrospective study was to investigate the incidence, preoperative risk factors, and early outcomes of delirium in a large group of patients undergoing valvular open-heart surgery. Methods In 13,229 patients with isolated valvular or combined valvular and bypass surgery, the incidence of postoperative delirium was assessed until discharge. Independent risk factors of delirium were evaluated by multivariable logistic regression analysis. Moreover, we assessed the multivariable-adjusted risk of prolonged intensive care unit (ICU) stay (>48 hours) and in-hospital mortality in patients with delirium. Results Overall, the incidence of postoperative delirium was 8.4%. The incidence in patients experiencing a postoperative stroke or seizure was 23.1 and 29.7%, respectively. Twelve preoperative risk factors, mostly nonmodifiable, were independently associated with the risk of delirium, including advanced age, renal impairment, stroke, the need for emergency surgery, and severe preoperative anemia (hemoglobin < 9 g/dL). Postoperative delirium was associated with an adjusted odds ratio (OR) of prolonged ICU stay of 9.48 (95% confidence interval [CI]: 7.96–11.30). Adjusted in-hospital mortality was, however, significantly lower in patients with delirium versus patients without delirium (OR, 0.56; 95% CI: 0.38–0.83). Conclusion In valvular open-heart surgery, postoperative delirium is a frequent neurological complication that is associated with other postoperative neurological complications and several, mostly nonmodifiable, preoperative risk factors. Although postoperative delirium was associated with a significantly increased risk of prolonged ICU stay, this did not translate into an increased short-term mortality.

Intraoperative low-dose dopamine is associated with worse survival in patients with hepatocellular carcinoma: A propensity score matching analysis

“…This difference may be attributable to higher doses of dopamine and longer use duration in Yilmaz’s study. In addition, delirium was very common after cardiac surgery ( 24 ). Therefore, further studies are required to evaluate the relationship between low-dose dopamine and clinical effects and its internal mechanism.…”

Pre- and intraoperative cerebral near-infrared spectroscopy and postoperative delirium: Results of a prospective cross-sectional trial

“…Other authors also identified preoperative anemia as a risk factor for delirium after non-cardiac as well as after cardiac surgery. [29–32]…”

“…Other authors also identified preoperative anemia as a risk factor for delirium after non-cardiac as well as after cardiac surgery. [29][30][31][32] Recently, consensus recommendations from an international conference on the role of perioperative cerebral NIRS were published. [33] With regard to preoperative values, the authors state that they recommend the use of preoperative cerebral oximetry to identify patients at increased risk of adverse outcomes after cardiac surgery.…”

Impact of intraoperative dexmedetomidine on postoperative delirium and pro-inflammatory cytokine levels in elderly patients undergoing thoracolumbar compression fracture surgery: A prospective, randomized, placebo-controlled clinical trial

“…[ 4 ] Additionally, POD manifests more intensely in elderly patients compared to younger cohorts, complicating post-surgical family communications and intensifying already strained relationships between healthcare providers and patients. The incidence of POD varies significantly across surgical procedures (ranging from 4.1% to 67%), [ 5 , 6 ] underscoring its complex etiology. Identified risk factors include preoperative anxiety, [ 7 ] smoking history, [ 8 ] hypertension, [ 9 ] the use of sleeping pills, open surgical techniques, [ 10 ] as well as heightened levels of postoperative pain and opioid consumption.…”