Abstract
Background and Objective: Hallucinations after cardiac surgery can be a burden, but their prevalence and phenomenology have not been studied well. Risk factors for postoperative hallucinations, as well as their relation to delirium are unclear. We aimed to study the prevalence and phenomenology of hallucinations after cardiac surgery, and to study the association between hallucinations and delirium in this population. Materials and Methods: We used the Questionnaire for Psychotic Experiences to detect hallucinations in cardiac surgery patients and a control group of cardiology outpatients. We assessed postoperative delirium with validated instruments. Risk factors for postoperative hallucinations and the association between hallucinations and delirium were analysed using logistic regression. Results: We included 201 cardiac surgery patients and 99 cardiology outpatient controls. Forty-four cardiac surgery patients (21.9%) experienced postoperative hallucinations in the first four postoperative days. This was significantly higher compared to cardiology outpatient controls (n = 4, 4.1%, p < 0.001). Visual hallucinations were the most common type of hallucinations in cardiac surgery patients, and less common in outpatient controls. Cardiac surgery patients who experienced hallucinations were more likely to also have delirium (10/44, 22.7%) compared to patients without postoperative hallucinations (16/157, 10.2% p = 0.03). However, the majority of patients with postoperative hallucinations (34/44, 77.3%) did not develop delirium. Conclusion: After cardiac surgery, hallucinations occurred more frequently than in outpatient controls. Hallucinations after cardiac surgery were most often visual in character. Although postoperative hallucinations were associated with delirium, most patients with hallucinations did not develop delirium.
Highlights
Cardiac surgery often improves patients’ quality of life [1], but can be complicated by cerebral complications, including hallucinations [2,3,4]
In this prospective study of the prevalence, phenomenology and risk factors of postoperative hallucinations after cardiac surgery, we found that 21.9% of cardiac surgery patients experienced postoperative hallucinations
This study did not investigate the pathophysiology behind the occurence of postoperative hallucinations, the high incidence of hallucinations after cardiac surgery may be explained by many factors, such as the use of high doses of opioids during anesthesia, the administration of other hallucinogenic medications in the perioperative phase, and potentially the systemic inflammation induced by the major surgery and cardiopulmonary bypass
Summary
Cardiac surgery often improves patients’ quality of life [1], but can be complicated by cerebral complications, including hallucinations [2,3,4]. Very little is known about the prevalence, risk factors and phenomenology of postoperative hallucinations. Clinical studies on hallucinations in cardiac surgery patients are sparse; we could only identify two case reports, one case series of three patients and one prospective observational study that included 52 patients [2,3,5,6]. Risk factors for postoperative hallucinations, as well as their relation to delirium are unclear. Forty-four cardiac surgery patients (21.9%) experienced postoperative hallucinations in the first four postoperative days
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