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Postcardiotomy delirium: conclusions after 25 years?

L W Smith1, J E Dimsdale

  • 1Department of Psychiatry, University of California, San Diego, La Jolla 92093-0804.

The American Journal of Psychiatry
|April 1, 1989
PubMed
Summary

Post-cardiac surgery delirium remains prevalent at 32%, with preoperative psychiatric intervention showing the strongest protective effect. This finding highlights the importance of mental health support before heart surgery.

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Area of Science:

  • Cardiology
  • Psychiatry
  • Medical Informatics

Background:

  • Postcardiotomy delirium is a known complication after heart surgery.
  • Limited current data exists on its prevalence compared to historical reports.
  • Replication of early findings has been infrequent.

Purpose of the Study:

  • To determine the current prevalence of postcardiotomy delirium.
  • To identify risk factors associated with postcardiotomy delirium.
  • To update understanding of this postoperative complication.

Main Methods:

  • A meta-analysis was conducted, combining data from 44 studies.
  • The study examined relationships between postcardiotomy delirium and 28 potential risk variables.
  • Prevalence was compared between studies using interviews versus chart reviews.

Main Results:

  • The overall prevalence of postcardiotomy delirium was found to be 32%.
  • No significant difference in prevalence was observed between interview-based and chart-review studies.
  • Age and time on bypass showed only slight correlation; sex, prior psychiatric illness, and intelligence did not correlate.
  • Noncongenital heart disease and postoperative EEG abnormalities showed moderate correlation (r > 0.30).
  • Preoperative psychiatric intervention demonstrated the highest negative correlation (r = -0.60), indicating a protective effect.

Conclusions:

  • The prevalence of postcardiotomy delirium has remained stable over time.
  • Preoperative psychiatric intervention is a significant factor in reducing the incidence of postcardiotomy delirium.
  • Further research should focus on the impact of psychological interventions in cardiac surgery patients.

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