Effect of care bundle in preventing delirium after bypass surgery: a single-blind, non-randomised clinical trial

Delirium is a common complication following coronary artery bypass graft (CABG) surgery, associated with longer hospital stays, increased morbidity, and higher healthcare costs.

To evaluate the effectiveness of a multicomponent care bundle in preventing postoperative delirium among patients undergoing CABG surgery.

This single-blind, non-randomised trial included 94 patients consecutively allocated by time period (47 per group). The primary outcome was delirium incidence at postoperative day 1 assessed by a blinded neurologist using DSM-5 criteria. Delirium subtypes were classified by RASS scores. The control group received standardised care; the study group received standardised care plus continuous family presence, patient-selected music, and earplug use. Cortisol, ACTH, glucose, sleep quality, pain, and anxiety were evaluated. Statistical significance was set at p < 0.05.

At postoperative day 1, delirium incidence assessed by DSM-5 criteria was 14.9% in the study group vs. 38.3% in controls (p = 0.013; OR = 0.28, 95% CI: 0.10-0.76; ARR = 23.4%). Hyperactive delirium was markedly lower (2.1% vs. 14.9%). At postoperative days 1 and 2, cortisol, ACTH, glucose, pain, and anxiety levels were lower, and sleep quality was higher in the study group. Adherence to all bundle components exceeded 90%.

The multicomponent care bundle was associated with significant reduction in postoperative delirium (NNT = 4.3), particularly hyperactive delirium, and improvements in stress biomarkers and psychological well-being. High adherence supports feasibility of this low-cost, nurse-led intervention. Randomised trials are needed to confirm causality.