Does the Development of Delirium Predict Lower Survival and Increased Morbidity After Cardiac Surgery? A...

Post-Operative Delirium (POD) is common post-operative complications that is under-recognized though it is clinically significant. Delirium management can vary according to the local and the policies of the Centre, hospital and countries but it is management is mostly to treat the predisposing and precipitating factors given that it is consider a medical emergency. It is associated risk to post-operative outcomes in cardiac surgery is limited and understanding its effect might help shed the light to more robust screening and management in CCU and ICU center which could improve the survival and morbidity rate post-cardiac surgery operations.

We conducted a retrospective cohort study at Al-Azhar University Hospitals including adult patients who underwent cardiovascular surgery. Eligible procedures comprised coronary artery bypass grafting, aortic surgery, valve surgery, or combined procedures. Exclusion criteria were: age <18 years; preoperative history of dementia or cognitive impairment; non-direct vision procedures (including aortic stent implantation and transcatheter aortic valve implantation); cardiovascular surgery combined with other thoracic surgeries; preoperative coma; repeat surgery within 3 days; death within 3 days after surgery; and incomplete clinical data. POD was assessed during the postoperative period using routine Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) screening, with diagnoses aligned to 11th Revision of the International Classification of Diseases (ICD-11) criteria. The primary outcomes were all-cause mortality at 30 days and 1 year. Secondary outcomes included postoperative morbidity indicators: intensive care unit (ICU) readmission, major complications (infection, stroke, and acute kidney injury), and duration of ICU and hospital stay. Associations between delirium and postoperative outcomes were analyzed using multivariable statistical models with adjustment for relevant clinical covariates.

Among records of 152 patients, 37 (24.3%) of them were diagnosed with POD and 115 showed no POD. Patients in POD group were significantly older (69.56±5.85 vs 66.79±5.18 years), more obese (BMI 27.01±1.85 vs 25.63±2.37), had lower educational attainment (2.7% vs 22.6%), and they had a higher CCI (5.67±0.91 vs 4.37±1.55) compared with the NO-POD group respectively. Factors associated with the risk of POD were advancing age (OR=1.002), lower educational level (OR=1.279), CCI (OR=1.587), duration of anesthesia (OR=1.031), volume of blood transfusion (OR=1.001), duration of the bypass (OR=1.037), and duration of the surgery (OR=0.137), while factors associated with a lower one-year survival rate were delirium itself (p<0.001), age (p=0.002), volume of blood transfusion (p<0.001), CCI (p<0.001), duration of the surgery (p0.037), ICU length of stay (p=0.002), and readmission to the ICU (p=0.001).

POD is under-recognized postoperative serious complication, it decreases the 30 days and 1 year and increase the post-op morbidities (ICU readmission, major complications, Length of ICU and hospital stay) specially in patients with preoperative co-morbidities.