Risk and Consequences of Postoperative Delirium in Cardiac Surgery

Abstract

Background Delirium is a common complication after cardiac surgery that leads to increased costs and worse outcomes. This retrospective study evaluated the potential risk factors and postoperative impact of delirium on cardiac surgery patients. Methods One thousand two hundred six patients who underwent open-heart surgery within a single year were included. Uni- and multivariate analyses of a variety of pre, intra-, and postoperative parameters were performed according to differences between the delirium (D) and nondelirium (ND) groups. Results The incidence of delirium was 11.6% (n = 140). The onset of delirium occurred at 3.35 ± 4.05 postoperative days with a duration of 5.97 ± 5.36 days. There were two important risk factors for postoperative delirium: higher age (D vs. ND, 73.1 ± 9.04 years vs. 69.0 ± 11.1 years, p < 0.001) and longer aortic cross-clamp time (D vs. ND, 69.8 ± 49.9 minutes vs. 61.6 ± 53.8 minutes, p < 0.05). We found that delirious patients developed significantly more frequent postoperative complications, such as myocardial infarction (MI) (D vs. ND, 1.43% [n = 3] vs. 0.28% [n = 2], p = 0.05), cerebrovascular accident (D vs. ND, 10.7% [n = 15] vs. 3.75% [n = 40], p < 0.001), respiratory complications (D vs. ND, 16.4% [n = 23] vs. 5.72% [n = 61], p < 0.001), and infections (D vs. ND, 36.4% [n = 51] vs. 16.0% [n = 170], p < 0.001). The hospital stay was longer in cases of postoperative delirium (D vs. ND, 23.2 ± 13.6 days vs. 17.4 ± 12.8 days, p < 0.001), and fewer patients were discharged home (D vs. ND, 56.0% [n = 65] vs. 66.8% [n = 571], p < 0.001). Conclusions Because the propensity for delirium-related complications is high after cardiac surgery, a practical, preventative strategy should be developed for patients with perioperative risk factors, including higher age and a longer cross-clamp time.

Construction and Application of a Model for Predicting the Risk of Delirium in Postoperative Patients With Type a Aortic Dissection

“…The Melbourne Group Scale (MGS) ( 61 ) was used in this study to assess the occurrence of PPC in patients: Temperature>38°C, White cell count >11.2 or respiratory, antibiotics, Physician diagnosis of pneumonia or chest infection, Chest X-ray report of atelectasis/consolidation, Production of purulent (yellow/green), sputum differing from preoperative Positive signs on sputum microbiology, SpO 2 < 90% on room air and Re-admission to or prolonged stay (over 36 h) on the intensive care unit/high dependency unit for respiratory problems PPC = four or more positive variables. Studies have shown multiple correlations between pulmonary complications and POD, which are mutually causal ( 62 ). Patients with pulmonary complications after aortic dissection surgery are prone to hypoxemia, which causes cerebral hypoperfusion and leads to neuroinflammation, as a cause of POD ( 63 ).…”

Risk Factors Associated with an Increased Risk of Deep Sternal Wound Infections in Patients After Coronary Artery Bypass Grafting and Heart Defect Surgery

“…Delirium represented 42% of people in the case group, where CPB time had a relevant association with infectious complications. Similarly, longer aortic cross-clamp time was found to be a risk factor for postoperative delirium in one study [Sugimura 2020], and a longer duration of extracorporeal circulation was associated with the presence of delirium in others [Jones 2019;Sanson 2018].…”

Gender Differences and Postoperative Delirium in Adult Patients Undergoing Cardiac Valve Surgery

“…We selected 21 perioperative demographic data or potential risk factors based on the previous studies and clinical experience ( 22 , 23 ). Two researchers independently collected the perioperative parameters based on medical record.…”