Postoperative visual and auditory hallucinations after cardiac surgery: VAACS umbrella study

Area of Science:

• Neuroscience
• Cardiology
• Psychiatry

Background:

• Hallucinations are frequently underrecognized neuropsychiatric complications following cardiac surgery.
• Limited data exists on the incidence and specific predictors of visual and auditory hallucinations after coronary artery bypass grafting (CABG) and valvular surgery.

Purpose of the Study:

• To investigate the incidence and identify predictors of visual and auditory hallucinations in patients undergoing CABG and valvular surgery.
• To provide data that supports tailored monitoring and prevention strategies for postoperative hallucinations.

Main Methods:

• A multicenter prospective cohort study involving 1332 adult patients (997 CABG, 335 valve) was conducted.
• Patients were assessed daily for 7 days postoperatively using the Questionnaire for Psychotic Experiences.
• Cox proportional hazards models were used to evaluate predictors of visual and auditory hallucinations.

Main Results:

• Visual hallucinations occurred in 11.5% of CABG patients and 10.0% of valve surgery patients.
• Auditory hallucinations were reported in 7.0% of CABG patients and 5.0% of valve surgery patients.
• Predictors varied by surgery type, including lower left ventricular ejection fraction, longer aortic cross-clamp time, immunosuppressive therapy, postoperative blood transfusion, prolonged postoperative ventilation, noradrenalin use, and adrenaline exposure.

Conclusions:

• Approximately 1 in 10 patients experience postoperative hallucinations after cardiac surgery.
• Visual hallucinations are more frequent than auditory hallucinations.
• The risk factors and protective elements for hallucinations differ between CABG and valve surgery, highlighting the need for individualized care.