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The Cognitive Functions in Patients With Postoperative Delirium Undergoing Cardiac Surgery After ICU Discharge: A
Vincenza Giordano1, Francesco Gravante2, Simone Amato3
1Department of Public Health, University of Naples Federico II, Naples, Italy.
Insights
Postoperative delirium (POD) significantly impairs cognitive function in cardiac surgery patients long after ICU discharge. This systematic review highlights memory, attention, and orientation deficits, emphasizing the need for better patient care.
Area of Science:
- Neuroscience
- Critical Care Medicine
- Cardiology
Background:
- Postoperative delirium (POD) is a common neurobehavioral complication following intensive care unit (ICU) admission.
- Limited understanding exists regarding the long-term effects of POD on cognitive functions specifically in cardiac surgery (CS) patients.
Purpose of the Study:
- To systematically review and describe the impact of postoperative delirium (POD) on cognitive function in patients undergoing cardiac surgery (CS) after their ICU discharge.
Main Methods:
- A systematic review adhering to PRISMA guidelines was conducted.
- Inclusion criteria focused on studies examining the POD-cognitive function relationship in CS patients, excluding secondary studies and those on dementia.
- The review was registered in PROSPERO (ID: CRD42024560306).
Main Results:
- Ten studies were included from 2540 screened records, with 8 at OCEBM level 3 and 4 of high methodological quality.
- Four studies identified POD as an independent risk factor for cognitive impairment post-CS.
- Cognitive deficits, including memory, orientation, concentration, and attention, were observed up to 36 months post-discharge.
Conclusions:
- Postoperative delirium (POD) is prevalent in cardiac surgery (CS) patients and leads to significant, long-term cognitive impairments post-ICU discharge.
- Patient and caregiver data underscore the profound impact of POD on cognitive health, necessitating enhanced clinical management strategies.
Background:
Postoperative delirium (POD) is a neurobehavioral disorder that occurs during intensive care unit (ICU) admission. There is a lack of knowledge about POD and cognitive functions in cardiac surgery (CS) patients.
Objectives:
To describe the impact of POD on cognitive function in patients undergoing CS after discharge from the ICU.
Methods:
A systematic review followed the PRISMA guidelines. The inclusion criteria were studies explaining the relationship between POD and cognitive functions, while we excluded secondary studies, studies on dementia, and studies using languages other than English. This review was registered in the PROSPERO database (ID: CRD42024560306).
Results:
A total of 2540 records were screened. We included 10 studies. Eight studies reported evidence of level 3 (OCEBM level), and 4 had high methodological quality (JBI score). Four studies reported POD as a significant independent risk factor for cognitive impairment after CS. Four studies reported a positive association between POD and cognitive function 1 month after discharge, 3 studies reported it at 6 and 12 months after discharge, and 2 studies showed the effects on cognitive function at 36 months. The cognitive functions most affected in the patients who developed POD were memory, orientation, concentration, visual construction, language, and attention.
Conclusions:
POD in patients with CS is a widespread problem that negatively affects cognitive function after ICU discharge. Patients undergoing CS and caregivers shared vital data on cognitive impairments after ICU admission. Their long-term participation highlighted postoperative delirium's impact, stressing the need for improved care.
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