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Abstract
BackgroundAlthough many studies have reported numerous risk factors for postoperative delirium, data are scarce about preoperative anxiety as a risk factor. The study aimed to investigate the association between preoperative anxiety and postoperative delirium in older patients undergoing cardiac surgery.MethodsSecondary data analysis of a randomized, observer-blind, controlled trial. A total of 190 patients 65 years or older and admitted to the intensive care unit and cardiac surgery unit of a university hospital scheduled for elective on-pump cardiac surgery were included. State anxiety was measured preoperatively using the Amsterdam Preoperative Anxiety and Information Scale and the Visual Analogue Scale for anxiety. Incidence of delirium was measured during the first 5 postoperative days using the Confusion Assessment Method for Intensive Care Unit (when ventilated), or the 3 Minute Diagnostic Interview for Confusion Assessment Method (when extubated) and by daily chart review.ResultsPreoperative state anxiety was reported by 31% of the patients and 41% had postoperative delirium. A multiple step logistic regression analyses revealed no association between preoperative anxiety and postoperative delirium. Significant risk factors for postoperative delirium were age (OR = 1.10, 95% CI (1.03–1.18)), activities of daily living (0.69, 95% CI (0.50–0.96)), diabetes mellitus (OR = 3.15, 95% CI (1.42–7.00)) and time on cardiopulmonary bypass (OR = 1.01, 95% CI (1.00 to 1.02)).ConclusionsNo relationship could be found between preoperative anxiety and postoperative delirium.
Highlights
Many studies have reported numerous risk factors for postoperative delirium, data are scarce about preoperative anxiety as a risk factor
Incidence of preoperative anxiety and need for information A total of 59 patients (31%) had state anxiety symptoms prior to surgery according to the Amsterdam Preoperative Anxiety and Information Scale (APAIS)-A subscale
Compared to the few studies investigating the relationship between preoperative anxiety and postoperative delirium [10,11,12,13,14], the current study is the first study to investigate this relation by using measurement scales (e.g. APAIS and Visual Analogue Scale for anxiety (VAS-A) scale) designed to evaluate state anxiety related to the specific situation the patient is confronted with
Summary
Many studies have reported numerous risk factors for postoperative delirium, data are scarce about preoperative anxiety as a risk factor. The study aimed to investigate the association between preoperative anxiety and postoperative delirium in older patients undergoing cardiac surgery. Delirium has been associated with various adverse health outcomes, including cognitive and functional decline, higher morbidity and mortality, increased intensive care unit and hospital length of stay, and higher risk for institutionalization; and leading to additional healthcare costs [1, 5]. Several precipitating risk factors are involved including non-surgical (e.g. electrolyte disturbances, myocardial and pulmonary disorders, reduced sensory input, medication related problems such as newly initiated medication, increased doses, interactions etc.), as well as surgical risk factors (e.g. type and complexity of surgery, operative and anesthesia factors and postoperative complications such as pain, hypoxemia and infection) [3,4,5]
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