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Published on: November 28, 2018
Risk factors for postoperative delirium after cardiac surgical procedures with cardioplegic arrest
Terézia B Andrási1, Ildar Talipov1, Gerhard Dinges2
1Department of Cardiac Surgery, Philipps University of Marburg, Marburg, Germany.
Insights
Postoperative delirium risk factors vary by cardiac surgery type. Age, cardiopulmonary bypass time, ventilation, transfusions, and atrial fibrillation are key predictors, informing risk assessment and patient care strategies.
Area of Science:
- Cardiology
- Anesthesiology
- Gerontology
Background:
- Delirium following cardiac surgery presents complex challenges.
- Identifying perioperative risk factors is crucial for patient management.
Purpose of the Study:
- To determine perioperative risk factors for delirium after cardiac surgery.
- To develop a predictive scoring system for postoperative delirium tailored to surgery type.
Main Methods:
- Retrospective analysis of 300 patients undergoing coronary artery bypass grafting (CABG) or valve/aortic surgery.
- Multivariate regression analysis to identify significant risk factors.
- K-fold logistic regression for model validation and accuracy assessment.
Main Results:
- Delirium incidence was 32%, with similar rates across subgroups.
- Key predictors identified: age, cardiopulmonary bypass (CPB) time, fresh frozen plasma transfusion, and atrial fibrillation for valve/aortic surgery.
- Age and ventilation time were significant for isolated CABG.
- Prediction models achieved AUCs of 0.835 and 0.798, with overall accuracy of 0.764.
Conclusions:
- Perioperative risk factors for delirium differ based on cardiac surgery type (CABG vs. valve/aortic).
- Age, CPB time, ventilation, transfusions, and atrial fibrillation are significant predictors.
- Risk calculators and optimized intraoperative management can improve outcomes by enabling early interventions.
Objectives:
The pathophysiology of delirium after cardiac surgery is complex. The present study aims to determine perioperative risk factors and construct a scoring system for postoperative delirium based on the type of surgery.
Methods:
Three hundred patients undergoing coronary artery bypass grafting (CABG; n = 150) or valve and/or aortic surgery ± CABG (n = 150) were retrospectively evaluated.
Results:
The incidence of delirium (32%) was similar in subgroups (28.7% and 33.33%, P = 0.384). Delirium patients were older [71.3 (standard deviation: 8.5) vs 66.6 (standard deviation: 9.5), P < 0.001; 70.0 (standard deviation: 9.6) vs 62.5 (standard deviation: 12.6), P < 0.001] and required more packed red blood cell units [2.1 (standard deviation: 2.1) vs 4.2 (standard deviation: 4.0), P < 0.001; 2.4 (standard deviation: 3.3) vs 5.4 (standard deviation: 5.9), P < 0.001] and fresh frozen plasma units [6.1 (standard deviation: 2.9) vs. 8.0 (standard deviation: 4.2), P < 0.001; 6.3 (standard deviation: 3.4) vs 10.8 (standard deviation: 7.2), P < 0.001] in CABG and valve/aortic subgroups, respectively. Delirium was associated with longer operation time [298.3 (standard deviation: 98.4) vs 250.6 (standard deviation: 67.8) min, P < 0.001], cardiopulmonary bypass (CPB) time [171.5 (standard deviation: 54.9) vs 140.98 (standard deviation: 45.8) min, P < 0.001] and cardiac arrest time [112 (standard deviation: 35.9) vs 91.9 (standard deviation: 28.6), P < 0.001] only in the valve/aortic group (versus non-delirium). Multivariate regression analysis identified an association between delirium and age [odds ratio: 1.056 (95% confidence interval: 1.002-1.113), P = 0.041], CPB time [odds ratio: 1.1014 (95% confidence interval: 1.004-1.025), P = 0.007], fresh frozen plasma transfusion [odds ratio: 1.127 (95% confidence interval: 1.006-1.262), P = 0.039] and atrial fibrillation [odds ratio: 4.801 (95% confidence interval: 1.844-12.502), P < 0.001] after valve/aortic surgery (area under the curve 0.835, P < 0.001) and between delirium and age [odds ratio: 1.089 (95% confidence interval: 1.023-1.160), P = 0.007] and ventilation time [odds ratio: 1.068 (95% confidence interval: 1.026-1.113), P = 0.001] after isolated CABG (area under the curve 0.798, P < 0.001). The cross-validation of the results by k-fold logistic regression revealed for the entire patient cohort an overall average accuracy of the prediction model of 0.764, with a false-positive rate of 0.052 and a false-negative rate of 0.18.
Conclusions:
Age, CPB time, ventilation, transfusion and atrial fibrillation are differently associated with delirium depending on the operative characteristics. Optimization of intraoperative parameters and use of risk calculators may enable early institution of pharmacotherapy and improve overall outcome after cardiac surgery.
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