Abstract
IntroductionDelirium is the most common neurological complication following cardiac surgery. Much research has focused on potential causes of delirium; however, the sequelae of delirium have not been well investigated. The objective of this study was to investigate the relationship between delirium and sepsis post coronary artery bypass grafting (CABG) and to determine if delirium is a predictor of sepsis.MethodsPeri-operative data were collected prospectively on all patients. Subjects were identified as having agitated delirium if they experienced a short-term mental disturbance marked by confusion, illusions and cerebral excitement. Patient characteristics were compared between those who became delirious and those who did not. The primary outcome of interest was post-operative sepsis. The association of delirium with sepsis was assessed by logistic regression, adjusting for differences in age, acuity, and co-morbidities.ResultsAmong 14,301 patients, 981 became delirious and 227 developed sepsis post-operatively. Rates of delirium increased over the years of the study from 4.8 to 8.0% (P = 0.0003). A total of 70 patients of the 227 with sepsis, were delirious. In 30.8% of patients delirium preceded the development of overt sepsis by at least 48 hours. Multivariate analysis identified several factors associated with sepsis, (receiver operating characteristic (ROC) 79.3%): delirium (odds ratio (OR) 2.3, 95% confidence interval (CI) 1.6 to 3.4), emergent surgery (OR 3.3, CI 2.2 to 5.1), age (OR 1.2, CI 1.0 to 1.3), pre-operative length of stay (LOS) more than seven days (OR 1.6, CI 1.1 to 2.3), pre-operative renal insufficiency (OR 1.9, CI 1.2 to 2.9) and complex coronary disease (OR 3.1, CI 1.8 to 5.3).ConclusionsThese data demonstrate an association between delirium and post-operative sepsis in the CABG population. Delirium emerged as an independent predictor of sepsis, along with traditional risk factors including age, pre-operative renal failure and peripheral vascular disease. Given the advancing age and increasing rates of delirium in the CABG population, the prevention and management of delirium need to be addressed.
Highlights
Delirium is the most common neurological complication following cardiac surgery
Rates of sepsis were higher in Nova Scotia than Manitoba (2.32% versus 0.85%, P < 0.001), but rates of delirium were equivalent (P = 0.32), as were rates of delirium in the septic patients (P = 0.06)
It has previously been established in non-cardiac surgical and intensive care populations that delirium is associated with an increased risk for in-hospital morbidity, and poorer long-term outcomes. We have identified another adverse outcome associated with delirium: sepsis
Summary
Delirium is the most common neurological complication following cardiac surgery. The objective of this study was to investigate the relationship between delirium and sepsis post coronary artery bypass grafting (CABG) and to determine if delirium is a predictor of sepsis. A significant number of patients, especially the elderly, develop peri-operative neurological complications ranging from subtle cognitive dysfunction and mild confusion to frank delirium, and occasionally permanent stroke. The importance of delirium is frequently dismissed, as it is seen as a transient entity. It is, the most common neurological complication after cardiac surgery [5]. Multiple pre-operative predictors of delirium have been uncovered including advanced age, previous stroke, and various medications [5]. The efficacy of delirium treatment strategies published far are at best modest [6]
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