Physical Performance and Risk of Postoperative Delirium in Older Adults Undergoing Aortic Valve Replacement.

Abstract

BackgroundDelirium is a major risk factor for poor recovery after surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR). It is unclear whether preoperative physical performance tests improve delirium prediction.ObjectiveTo examine whether physical performance tests can predict delirium after SAVR and TAVR, and adapt an existing delirium prediction rule for cardiac surgery, which includes Mini-Mental State Examination (MMSE), depression, prior stroke, and albumin level.DesignProspective cohort, 2014–2017.SettingSingle academic center.SubjectsA total of 187 patients undergoing SAVR (n=77) or TAVR (n=110).MethodsThe Short Physical Performance Battery (SPPB) score was calculated based on gait speed, balance, and chair stands (range: 0–12 points, lower scores indicate poor performance). Delirium was assessed using the Confusion Assessment Method. We fitted logistic regression to predict delirium using SPPB components and risk factors of delirium.ResultsDelirium occurred in 35.8% (50.7% in SAVR and 25.5% in TAVR). The risk of delirium increased for lower SPPB scores: 10–12 (28.2%), 7–9 (34.5%), 4–6 (37.5%) and 0–3 (44.1%) (p-for-trend=0.001). A model that included gait speed <0.46 meter/second (OR, 2.7; 95% CI, 1.2–6.4), chair stands time ≥11.2 seconds (OR, 3.5; 95% CI, 1.0–12.4), MMSE <24 points (OR, 2.9; 95% CI, 1.3–6.4), isolated SAVR (OR, 5.4; 95% CI, 2.1–13.8), and SAVR and coronary artery bypass grafting (OR, 15.8; 95% CI, 5.5–45.7) predicted delirium better than the existing prediction rule (C statistics: 0.71 vs 0.61; p=0.035).ConclusionAssessing physical performance, in addition to cognitive function, can help identify high-risk patients for delirium after SAVR and TAVR.