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

Haitham Abu Khadija1, Nizar Abu Hamdeh2, Duha Najajra2

  • 1Heart Center, Kaplan Medical Center, Pasternak St. 1 Rehovot, Affiliated with the Hebrew University, Jerusalem, Israel.

Journal of Psychosomatic Research
|January 21, 2026
PubMed

Insights

Postoperative hallucinations affect about 10% of cardiac surgery patients, with visual hallucinations being more common. Risk factors and protective measures vary by surgery type, necessitating tailored patient monitoring and prevention strategies.

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.
Abstract

Keywords:
Auditory hallucinationsCABGCardiac surgeryCox regressionCritical careImmunosuppressionMechanical ventilationPostoperative hallucinationsRisk stratificationValve replacementVasopressorsVisual hallucinations

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