Abstract
BackgroundPrevious studies have shown a relationship between delirium and depressive symptoms after cardiac surgery with distress personalities linking to negative surgical outcomes. The aim of the present study is to further investigate the association between patients with Type D (distressed) personality with regards to delirium after cardiac surgery.MethodsWe conducted a consecutive-sample observational cohort pilot study with an estimated 142 patients needed. Enrollment criteria included patients aged ≥18 years who were undergoing planned cardiovascular, thoracic and abdominal artery surgery between October 2015 to August 2016 at the University of Tsukuba Hospital, Japan. All patients were screened by Type-D Personality Scale-14 (DS14) as well as the Hospital Anxiety and Depression Scale (HADS) the day before surgery. Following surgery, daily data was collected during recovery and included severity of organ dysfunction, sedative/analgesic exposure and other relevant information. We then evaluated the association between Type D personality and delirium/coma days (DCDs) during the 7-day study period. We applied regression and mediation modeling for this study.ResultsA total of 142 patients were enrolled in the present study and the total prevalence of delirium was found to be 34% and 26% of the patients were Type D. Non-Type D personality patients experienced an average of 1.3 DCDs during the week after surgery while Type D patients experienced 2.1 days over the week after surgery. Multivariate analysis showed that Type D personality was significantly associated with increased DCDs (OR:2.8, 95%CI:1.3–6.1) after adjustment for depressive symptoms and clinical variables. Additionally, there was a significant Type D x depression interaction effect (OR:1.7, 95% CI:1.2–2.2), and depressive symptoms were associated with DCDs in Type D patients, but not in non-Type D patients. Mediation modeling showed that depressive symptoms partially mediated the association of Type D personality with DCDs (Aroian test =0.04).ConclusionsType D personality is a prognostic predictor for prolonged acute brain dysfunction (delirium/coma) in cardiovascular patients independent from depressive symptoms and Type D personality-associated depressive symptoms increase the magnitude of acute brain dysfunction.
Highlights
Previous studies have shown a relationship between delirium and depressive symptoms after cardiac surgery with distress personalities linking to negative surgical outcomes
Of the 174 patients, the following two groups were excluded from the study: A) 16 patients: 2 deaf or unable to speak, 2 could not speak Japanese and 12 had stroke B) 16 patients that freely exercised their legal right to refuse participation
Based on the above analysis, our present findings show that Type D personality is an independent predictor of delirium/coma days (DCDs) and that depressive symptoms had a partial mediating effect on the relationship between Type D personality and DCDs after adjustment
Summary
Previous studies have shown a relationship between delirium and depressive symptoms after cardiac surgery with distress personalities linking to negative surgical outcomes. The main concept is that psychiatric disorders can often manifest alongside physical ailments and even if the physical condition causes the initial psychiatric insult, ongoing depressive symptoms can enact a positive feedback loop to worsen the physical condition To this end, previous studies reported that depressive symptoms are associated with delirium in cardiac patients [14]. About 30% of cardiac surgery patients that carry this personality [22] suffer adverse consequences [23] and previous research showed a significant association between Type D personality and hard endpoint-adjusted hazard ratios (HR:2.24, 95% CI [1.37–3.66]) in meta-analysis of 12 studies on 5341 patients [24] Despite this initial evidence linking Type D personality with hazard ratios, a full explanation of the correlation between personality and postoperative delirium which lead to high mortality is still lacking. Some points of improvement were noted in this previous study allowing for closer examination into important factors such as the severity and duration of delirium/coma take account for better patient outcomes
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