高齢者における大動脈弁置換術後の術後せん妄：後ろ向きコホート研究

To estimate the incidence of postoperative delirium (POD) and identify associated factors in adults ≥ 60 years with severe aortic stenosis undergoing surgical (SAVR) or transcatheter (TAVI) aortic valve replacement.

Consecutive, single-center retrospective cohort conducted at a tertiary hospital in Mexico (December 2023-May 2025). POD was defined as a positive Confusion Assessment Method (CAM) documented in the electronic health record, without formal blinding. Descriptive analyses, nonparametric tests, and univariable logistic regression were performed; given the low event frequency, an exploratory parsimonious multivariable model was fitted. Limitations: retrospective design, low number of events-particularly in TAVI-and lack of formal blinding for CAM assessment.

Seventy patients were included (58 SAVR and 12 TAVI). Overall POD incidence was 17.1% (95% CI: 10.1-27.6); SAVR 15.5% (9/58; 95% CI: 8.4-26.9) and TAVI 25.0% (3/12; 95% CI: 8.9-53.2) (p = 0.42). In the penalized (Firth) adjusted model, atrial fibrillation (OR: 11.17; 95% CI: 1.58-79.66; p = 0.038) and infections (OR: 5.03; 95% CI: 1.06-23.11; p = 0.042) were associated with POD. Hyponatremia occurred only among patients with POD.

POD was frequent after SAVR and TAVI. In exploratory penalized analyses, atrial fibrillation and infections were associated with POD, while hyponatremia was observed only among POD cases. These findings support focusing on feasible in-hospital preventive measures.