Incidence of and Risk Factors for Delirium After Cardiac Surgery at a Quaternary Care Center: A Retrospective Cohort Study

Published on Dec 1, 2015in Journal of Cardiothoracic and Vascular Anesthesia2.258
· DOI :10.1053/J.JVCA.2015.06.018
Lurdes Tse11
Estimated H-index: 11
(UBC: University of British Columbia),
Stephan K. W. Schwarz22
Estimated H-index: 22
(UBC: University of British Columbia)
+ 2 AuthorsAlasdair M. Barr48
Estimated H-index: 48
(UBC: University of British Columbia)
Sources
Abstract
Objective Delirium after cardiac surgery is associated with persistent cognitive deficits and increased mortality. The authors’ objective was to determine the incidence of and risk factors for delirium in a mixed cohort of patients undergoing on-pump and off-pump cardiac surgery and transcatheter aortic valve implantations (TAVI) in a Canadian quaternary care center. This study followed a pilot from the same center on patients treated in 2007. Design A retrospective cohort study. Setting A quaternary care center in Vancouver, B.C., Canada. Participants Patients undergoing cardiopulmonary bypass grafts (CABG), conventional valve replacements, combined CABG-valve replacements, transfemoral TAVI, or transapical TAVI in 2008. Interventions Data from 679 charts on demographics, medical history, medications, laboratory results, surgical procedure, and anesthesia were abstracted and analyzed using univariate and multivariate analyses. Nurses screened for delirium using the Confusion Assessment Method, and the final diagnoses were made clinically by physicians. Risk factors were identified using logistic regression and bootstrapping. Measurements and Main Results Delirium occurred in 28% of patients. Delirium was most common in transapical TAVI (47%), and least common in transfemoral TAVI (17%). Delirious patients were older and had greater preoperative cardiac and neurologic burdens than nondelirious patients. Age≥64 years, history of delirium, history of stroke/transient ischemic attack, cognitive impairment, depression, and preoperative use of beta-blocker(s) were associated independently with delirium. Conclusions The incidence of delirium varied greatly with the type of procedure. The authors’ logistic regression model showed that age and certain pre-existing neurologic conditions could predict delirium after cardiac surgery.
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Delirium is highly prevalent among elderly post-operative patients with no pharmacological intervention approved by the Food and Drug Administration for prevention or treatment. We conducted a systematic evidence review to critically appraise literature related to the pharmacotherapy of post-operative delirium. Ten studies fulfilled our inclusion criteria with two interventions for delirium treatment and eight interventions for delirium prevention in post-operative patients. The quality of evide...
8 CitationsSource
#1Lurdes Tse (UBC: University of British Columbia)H-Index: 11
#2John B. Bowering (UBC: University of British Columbia)H-Index: 7
Last. Alasdair M. Barr (UBC: University of British Columbia)H-Index: 48
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Purpose Transcatheter aortic valve implantation (TAVI) techniques show favourable survival outcomes in high-risk patients, but the incidence of postoperative delirium is unknown. We conducted a historical cohort study to compare postoperative delirium in retrograde transfemoral (TF) versus anterograde transapical (TA) TAVI procedures. We also sought to identify independent predictors of delirium following TAVI.
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#1Cyrus M. KosarH-Index: 14
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Summary Background Preoperative pain and depression predispose patients to delirium. We investigated whether pain and depressive symptoms interact to increase the risk of delirium. Methods We enrolled 459 people without dementia, who were aged 70 years or older and were scheduled for elective orthopaedic surgery between June, 2010, and August, 2013. At baseline, participants reported their current pain and the average and worst pain in the previous 7 days, on a scale of 0–10. Depressive symptoms...
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#1Benedikt TraboldH-Index: 13
#2Thomas Metterlein (University Hospital Regensburg)H-Index: 8
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POSTOPERATIVE DELIRIUM (POD) is a common perioperative complication frequently observed in cardiac surgical patients. Delirious patients exhibit an increased morbidity, a higher rate of cognitive deficits and a higher mortality. Furthermore, in cardiac surgery patients, POD results in a higher prevalence of sternum instability. Increasing medical and logistic challenges of prolonged intensive care unit and hospital stays lead to a relevant increase in postoperative expenses. Although delirium is...
35 CitationsSource
#1Łukasz J. Krzych (University of Silesia in Katowice)H-Index: 12
#2Maciej T. Wybraniec (University of Silesia in Katowice)H-Index: 11
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Objectives This study sought to evaluate the impact of postoperative delirium with/without cerebral ischemia on short- and long-term mortality in a large cohort of cardiac surgery patients. Design The study constituted a prospective cohort observation of patients following various cardiac surgery procedures. Setting The investigation was conducted in a single high-volume tertiary cardiac surgery center. Participants Consecutive candidates for cardiac surgery (n = 8,792) from 2003 to 2008 were su...
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#1Nina Smulter (Umeå University)H-Index: 6
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OBJECTIVES: Delirium after cardiac surgery is a problem with consequences for patients and healthcare. Preventive strategies from known risk factors may reduce the incidence and severity of delirium. The present aim was to explore risk factors behind delirium in older patients undergoing cardiac surgery with cardiopulmonary bypass. METHODS: Patients (≥70 years) scheduled for routine cardiac surgery were included (n= 142). The patients were assessed and monitored pre-/postoperatively, and deliriu...
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Postoperative delirium is a common medical complication following cardiac surgery. This paper will outline the treatment options for delirium with a focus on prophylactic use of risperidone before cardiac surgery. (J Card Surg 2012;27:589-593)
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Purpose: The objective of this review is to evaluate the literature on medications associated with delirium after cardiac surgery and potential prophylactic agents for preventing it.
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#2Edward R. Marcantonio (Harvard University)H-Index: 84
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BACKGROUND Delirium is common after cardiac surgery and may be associated with long-term changes in cognitive function. We examined postoperative delirium and the cognitive trajectory during the first year after cardiac surgery. METHODS We enrolled 225 patients 60 years of age or older who were planning to undergo coronary-artery bypass grafting or valve replacement. Patients were assessed preoperatively, daily during hospitalization beginning on postoperative day 2, and at 1, 6, and 12 months a...
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Abstract Study Objective To develop and validate a delirium risk prediction preoperative model for patients undergoing cardiac surgery. Design Observational prospective multicentre study. Setting Six intensive care units in Spain. Patients 689 patients undergoing cardiac surgery consecutively, aged ≥18 years. Measurements The primary outcome measure was the development of delirium, diagnosed using the Confusion Assessment Method in Intensive Care Units (CAM-ICU), during the stay in the intensive...
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