Abstract
ObjectivesThe aim of this study was to examine predictors and impact of postoperative delirium (POD) on outcome after percutaneous repair of mitral and tricuspid valves.BackgroundPOD is common in elderly patients and contributes to increased health care costs and worse outcome. Predictors of POD in percutaneous mitral or tricuspid valve procedures are unclear.MethodsIn a prospective single-center study, patients were screened for POD using the Confusion Assessment Method on the first and second postprocedural days, and up until 7 days in patients with clinical suspicion of delirium. Associations of POD with baseline characteristics, periprocedural outcome and mid-term mortality were examined.ResultsOne hundred and seventy-seven patients were included (median age 78 years [72–82], 41.8% female) and median (IQR) follow-up was 489 (293–704) days. Patients developing POD (n = 16, 9%) did not differ in baseline and procedural characteristics but more often received postinterventional blood transfusions (37.5% vs. 9.9%, p value = 0.007) and suffered from infections (43.8% vs. 9.9%, p value = 0.001). Patients with POD showed worse survival (HR: 2.71 [1.27–5.78]; p = 0.01), with an estimated 1-year survival of 46 ± 13% compared to 80 ± 3% in patients without POD (log-rank p value 0.007). In multivariate Cox regression, POD remained a significant predictor of mid-term mortality (HR 4.75 [1.97–11.5]; p = 0.001).ConclusionAfter percutaneous mitral or tricuspid valve repair, POD was independently associated with worse mid-term survival. Procedure- rather than patient-associated characteristics such as blood transfusions and infections emerged as important risk factors for development of POD. Considering the substantial prognostic impact of POD, further studies on its prevention are warranted to improve patient outcome.
Highlights
Delirium is a common organic brain syndrome with an acute onset of neurocognitive dysfunction
The interplay between preexisting morbidity and precipitating noxious insults such as major medical interventions can cause imbalance of brain chemistry and cerebral dysfunction resulting in postoperative delirium (POD)
Postprocedural infection was more frequent in patients developing POD (43.8% vs. 9.9%, p value = 0.001), with a 7.05-fold increased odds of POD
Summary
Delirium is a common organic brain syndrome with an acute onset of neurocognitive dysfunction. The pathophysiology of delirium is complex and not yet fully understood [1]. The interplay between preexisting morbidity and precipitating noxious insults such as major medical interventions can cause imbalance of brain chemistry and cerebral dysfunction resulting in postoperative delirium (POD). People and patients with functional impairment and complex multimorbidity seem to be especially vulnerable [2]. Hospitalized seniors are diagnosed with delirium in up to 50% and the number of unreported cases may be even higher, since delirium is overlooked in clinical routine [3, 4].
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