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Association Between Relative Plasma Hyperosmolality and Postoperative Delirium Following Cardiac Surgery: A Post Hoc
Helena Claesson Lingehall1, Staffan Svenmarker2, Micael Appelblad2
1Department of Nursing, Umeå University, Umeå, Västerbotten, Sweden; Department of Cardiothoracic Surgery, Örebro University Hospital, Örebro, Närke, Sweden.
Purpose:
To determine whether relative plasma hyperosmolality is independently associated with postoperative delirium (POD) and to explore the relationship between the cumulative number of concurrent perioperative variables and POD in patients aged greater than or equal to 65 years undergoing cardiac surgery.
Design:
Post hoc analysis.
Methods:
This post hoc analysis of a randomized controlled trial included 195 consecutive patients enrolled between March 2019 and June 2020 at a tertiary hospital in Sweden. The incidence of POD was 36% (70/195). POD was assessed preoperatively and postoperatively on days 1 and 3, based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Plasma osmolality was measured on five occasions and coordinated with POD assessments. Potential perioperative variables associated with POD were analyzed using a multivariable logistic regression model.
Findings:
The main findings indicate that relative hyperosmolality on the third postoperative day may represent a biochemical factor independently associated with the development of POD, and the presence of more than two concurrent perioperative factors, which may increase the likelihood of POD eightfold.
Conclusions:
Relative plasma hyperosmolality may be associated with POD after cardiac surgery. The accumulation of concurrent perioperative variables also appears important and supports further investigation of multicomponent prevention strategies. Multicenter studies are needed to confirm these findings.
