Postoperative Delirium In Patients Research Articles

Pharmacological prevention of postoperative delirium in patients undergoing cardiac surgery: a bayesian network meta-analysis.

The incidence of postoperative delirium in patients undergoing cardiac surgery is very high and increases morbidity and mortality. The possibility of pharmacological means to reduce its incidence is very attractive. At present, there is still no clear demonstration that any drug can prevent postoperative delirium in these patients. The aim of this Bayesian network meta-analysis (NMA) was to evaluate whether there is evidence that a drug is effective in reducing the incidence of POD in cardiac surgical patients. Our NMA showed that preoperative ketamine at subanesthetic doses can significantly reduce the incidence of POD. Risperidone also decreases the incidence of POD, but not significantly.

Preoperative Risk Factors Associated with Increased Incidence of Postoperative Delirium: Systematic Review of Qualified Clinical Studies.

Postoperative delirium (POD) is an acute alteration of mental state, characterized by reduced awareness and attention, occurring up to five postoperative days after recovery from anesthesia. Several original studies and reviews have identified possible perioperative POD risk factors; however, there is no comprehensive review of the preoperative risk factors in patients diagnosed with POD using only validated diagnostic scales. The aim of this systematic review was to report the preoperative risk factors associated with an increased incidence of POD in patients undergoing non-cardiac and non-brain surgery. The reviewed studies included original research papers that used at least one validated diagnostic scale to identify POD occurrence for more than 24 h. A total of 6475 references were retrieved from the database search, with only 260 of them being suitable for further review. Out of the 260 reviewed studies, only 165 that used a validated POD scale reported one or more preoperative risk factors. Forty-one risk factors were identified, with various levels of statistical significance. The extracted risk factors could serve as a preoperative POD risk assessment workup. Future studies dedicated to the further evaluation of the specific preoperative risk factors' contributions to POD could help with the development of a weighted screening tool.

A nomogram model for assessing predictors and prognosis of postoperative delirium in patients receiving acute type A aortic dissection surgery

BackgroundPostoperative delirium (POD) complicates the postoperative course. There is limited information on POD-related risk factors (RFs) and prognosis in patients with acute type A aortic dissection (ATAAD) after modified triple-branched stent graft implantation (MTBSG) surgery.MethodsWe retrospectively examined consecutive ATAAD patients who received MTBSG surgery in our hospital between January 2013 and December 2019. We employed univariate and multivariate analyses to identify stand-alone RFs for POD. A nomogram was next generated to estimate POD occurrence. The primary outcome was the development of POD, and the secondary outcomes were intensive care unit (ICU) and hospital stays, hospitalization costs, and in-hospital and follow-up mortality.ResultsWe selected 692 patients, of whom 220 experienced POD (31.8%). Based on our analysis, the following factors enhanced the likelihood of POD development: alcohol consumption (p < 0.001), acute physiology and chronic health evaluation II score (p = 0.023), serum total bilirubin (p = 0.007), stage 3 acute kidney injury (p < 0.001), serum interleukin-6 (p = 0.031), post-operative analgesics usage (p = 0.015), and ventilation duration (p = 0.008). POD patients had significantly longer ventilator times (p = 0.003), ICU stays (p < 0.001), and hospital stays (p = 0.038), together with increased hospitalization costs (p < 0.001) and in-hospital mortality (p = 0.019). However, POD was not a RF for mortality during follow-up (log-rank p = 0.611).ConclusionsWe demonstrated a strong link between POD and poor prognosis in ATAAD patients. We also constructed a prognosis estimator model which will benefit early management guidance to minimize the incidence of POD.

Systematic review and meta-analysis of the risk factors for postoperative delirium in patients with acute type A aortic dissection.

Delirium is a common postoperative complication of acute type an aortic dissection, which is a serious threat to the patient's life after operation. However, there are many risk factors for delirium and there are different conclusions. The aim of this study was to systematically analyze the risk factors for postoperative delirium in patients with acute type a aortic dissection by means of meta-analysis. Literature related to the risk factors of postoperative delirium in patients with acute type A aortic dissection was searched via the China National Knowledge Infrastructure (CNKI), cqvip.com (VIP), WanFang, PubMed, Willey Library, Embase, and Web of Science databases. Two persons independently conducted literature screening, data extraction and literature quality evaluation according to the inclusion and exclusion criteria. The quality of literature was evaluated with Newcastle-Ottawa Scale (NOS). R 4.2.1 was used to compare the risk factors for meta-analysis. After screening, 12 articles were included with a total of 2,511 cases, and 4 articles were at medium risk of bias and 8 articles were at low risk of bias. The meta-analysis results showed that patients in the delirium group had a higher probability of postoperative hypoxemia [odds ratio (OR) =1.65, 95% confidence interval (CI): 1.28-2.13, P<0.01], longer postoperative duration of ventilator assistance (OR =3.05, 95% CI: 2.47-3.77, P<0.01), higher incidence of renal insufficiency (OR =1.86, 95% CI: 1.33-2.58, P<0.01), lower hemoglobin levels (OR =0.33, 95% CI: 0.23-0.48, P<0.01), longer postoperative stay duration in the intensive care unit (ICU) (OR =2.25, 95% CI: 2.13-2.37, P<0.01), longer duration of hospitalization (OR =2.74, 95% CI: 2.37-3.16, P<0.01), and higher postoperative Acute Physiology and Chronic Health Evaluation II (APACHE II) scores (OR =1.01, 95% CI: 0.90-1.12, P=0.92). Post-op aortic dissection in patients with acute type A diabetes should be monitored for oxygen and blood levels. When patients had prolonged mechanical ventilation, renal insufficiency, decreased hemoglobin, and prolonged ICU stay, timely intervention is needed to prevent the high-risk factors of postoperative delirium.

Nighttime dexmedetomidine for delirium prevention in non-mechanically ventilated patients after cardiac surgery (MINDDS): a single-centre, parallel-arm, randomised, placebo-controlled superiority trial

The delirium-sparing effect of nighttime dexmedetomidine has not been studied after surgery. We hypothesised that a nighttime dose of dexmedetomidine would reduce the incidence of postoperative delirium as compared to placebo. This single-centre, parallel-arm, randomised, placebo-controlled superiority trial evaluated whether a short nighttime dose of intravenous dexmedetomidine (1μg/kg over 40min) would reduce the incidence of postoperative delirium in patients 60 years of age or older undergoing elective cardiac surgery with cardiopulmonary bypass. Patients were randomised to receive dexmedetomidine or placebo in a 1:1 ratio. The primary outcome was delirium on postoperative day one. Secondary outcomes included delirium within three days of surgery, 30-, 90-, and 180-day abbreviated Montreal Cognitive Assessment scores, Patient Reported Outcome Measures Information System quality of life scores, and all-cause mortality. The study was registered as NCT02856594 on ClinicalTrials.gov on August 5, 2016, before the enrolment of any participants. Of 469 patients that underwent randomisation to placebo (n=235) or dexmedetomidine (n=234), 75 met a prespecified drop criterion before the study intervention. Thus, 394 participants (188 dexmedetomidine; 206 placebo) were analysed in the modified intention-to-treat cohort (median age 69 [IQR 64, 74] years; 73.1% male [n=288]; 26·9% female [n=106]). Postoperative delirium status on day one was missing for 30 (7.6%) patients. Among those in whom it could be assessed, the primary outcome occurred in 5 of 175 patients (2.9%) in the dexmedetomidine group and 16 of 189 patients (8.5%) in the placebo group (OR 0.32, 95% CI: 0.10-0.83; P=0.029). A non-significant but higher proportion of participants experienced delirium within three days postoperatively in the placebo group (25/177; 14.1%) compared to the dexmedetomidine group (14/160; 8.8%; OR 0.58; 95% CI, 0.28-1.15). No significant differences between groups were observed in secondary outcomes or safety. Our findings suggested that in elderly cardiac surgery patients with a low baseline risk of postoperative delirium and extubated within 12h of ICU admission, a short nighttime dose of dexmedetomidine decreased the incidence of delirium on postoperative day one. Although non-statistically significant, our findings also suggested a clinical meaningful difference in the three-day incidence of postoperative delirium. National Institute on Aging (R01AG053582).

Two-stage prediction model for postoperative delirium in patients in the intensive care unit after cardiac surgery.

Postoperative delirium is a common severe complication in patients in the intensive care unit after cardiac surgery. We developed a two-stage prediction model and quantified the risk of developing postoperative delirium to assist in early prevention before and after surgery. We conducted a prospective cohort study and consecutively recruited adult patients after cardiac surgery. The Confusion Assessment Method for patients in the intensive care unit was used to diagnose delirium 5 days postoperatively. The stage I model was constructed using patient demographics, health conditions and laboratory results obtained preoperatively, whereas the stage II model was built on both pre- and postoperative predictors. The model was validated internally using the bootstrap method and externally using data from an external cohort. The two-stage model was developed with 654 patients and was externally validated with 214 patients undergoing cardiac surgery. The stage I model contained 6 predictors, whereas the stage II model included 10 predictors. The stage I model had an area under the receiver operating characteristic curve of 0.76 (95% confidence interval: 0.68-0.81), and the stage II model's area under the receiver operating characteristic curve increased to 0.85 [95% confidence interval (CI): 0.81-0.89]. The external validation resulted in an area under the curve of 0.76 (95% CI: 0.67-0.86) for the stage I model and 0.78 (95% CI: 0.69-0.86) for the stage II model. The two-stage model assisted medical staff in identifying patients at high risk for postoperative delirium before and 24 h after cardiac surgery. This model showed good discriminative power and predictive accuracy and can be easily accessed in clinical settings. The study was registered with the US National Institutes of Health ClinicalTrials.gov (NCT03704324; registered 11 October 2018).

The role of inflammatory parameters in the prediction of postoperative delirium in patients undergoing coronary artery bypass grafting.

In this study, we aimed to evaluate the association of pre-operative and early postoperative inflammatory parameters with postoperative delirium in patients operated on for coronary artery bypass grafting. The data of 1 279 cardiac surgery patients operated on between June 2014 and March 2020 were analysed retrospectively. Among these, 777 (61.2%) patients operated on for isolated coronary artery bypass grafting surgery with cardiopulmonary bypass were enrolled. Two groups were formed. The patients who developed postoperative delirium were placed in group 1 (n = 187) and the patients with uneventful postoperative follow up (n = 590) were enrolled in group 2. Pre- and early postoperative mean platelet volume, C-reactive protein level, erythrocyte sedimentation rate, platelet- to-lymphocyte ratio and neutrophil-to-lymphocyte ratio were elevated in group 1 (p = 0.0001). The APACHE II score and duration of hospital and intensive care unit stay were significantly elevated in group 1 (p < 0.05). An early-stage neurological event was observed in eight patients (4.3%) in group 1 and 12 patients (2%) in group 2, which was not statistically significantly different between the groups (p = 0.09). In-hospital mortality was observed in three patients (1.6%) in group 1 and five patients (0.8%) in group 2, which did not show a statistically significant difference (p > 0.05). In univariate and multivariate regression analysis, the pre-operative platelet-to-lymphocyte ratio (p = 0.013), mean platelet volume (p = 0.0001) and erythrocyte sedimentation rate (p = 0.002) were determined as independent risk factors for the occurrence of delirium in the early postoperative period. Also, the postoperative platelet-to-lymphocyte ratio (p = 0.0001), neutrophil-to-lymphocyte ratio (p = 0.0001) and erythrocyte sedimentation rate (p = 0.0001) were determined as independent risk factors for the occurrence of delirium in the early postoperative period. Pre- and early postoperative inflammatory parameters were observed to be predictors of postoperative delirium in patients operated on for coronary artery bypass grafting.

Frequency of Delirium Associated with Dexmedetomidine and Propofol in Post CABG Patients: A Comparative Study

Objective: To find out the frequency of delirium associated with peri-operative use of dexmetedomidine and propofol in post CABG patients.&#x0D; Study Design: Comparative Cross-sectional study.&#x0D; Place and Duration of Study: Adult Intensive Care unit, Department of Cardiac Anesthesiology and Intensive Care, Armed Force Institute of Cardiology, Rawalpindi Pakistan from Feb to Jun 2022.&#x0D; Methodology: All post CABG patients who have undergone elective surgery were included through non-probability consecutive sampling technique. All the delirious patients amongst them were subjected to a modified version of ICU-CAM to establish post-operative delirium (POD) caused by either dexmedetomidine or propofol. POD in both the category of patients was compared.&#x0D; Results: A total of 179 CABG patients were included in our study. 140(78.2%) of the patients were subjected to the use of dexmedetomidine throughout their surgery while 39(21.8%) of the patients were given propofol. After subjecting the patients to our exclusion criteria which aimed to eliminate the confounding causes of POD in post-CABG patients, only 30(16.8%) had delirium while 149(83.2%) didn’t develop delirium (p-value=0.003). Majority of the delirious patients were given dexmedetomidine (n=29; 20.77%) in the operation theatre while only a fraction (n=1; 2.58%) were given propofol. Average duration of ICU stay in our study population was 5 days. 15(8.4%) cases out of our total study population underwent reintubation and re-ventilation because of low cardiac output or respiratory distress.&#x0D; Conclusion: Dexmedetomidine could possibly be associated with POD in patients undergoing cardiac surgery. Propofol on the other hand is considerably safe in this regard and doesn’t cause POD.

Association between preoperative on-site CCU visits and postoperative delirium in patients undergoing cardiac surgery: A retrospective cohort study.

Postoperative delirium (POD) is a common complication after cardiac surgery (CS), with symptoms like attention disorders and even delays patients' recovery. To evaluate the impact of preoperative on-site visits in the cardiac care unit (CCU) on POD after CS. Patients admitted to the CCU with extracorporeal CS were included in the visiting or non-visiting group according to whether they were on visiting week. The visiting group received a preoperative visit from a nurse-led multidisciplinary visiting team (including CCU nurses and physicians) 1 week before surgery in addition to standard care. The non-visiting group received standard care like unstructured information from the CS team and anesthesiologists and so on. The Confusion Assessment Method for the ICU (CAM-ICU) and the Intensive Care Delirium Screening Checklist (ICDSC) were used to evaluate the POD severity. The incidence, occurrence and duration of POD, as well as the CCU length of stay, postoperative mechanical ventilation duration and length of hospital stay were compared between the two groups. A total of 735 participants (369 in the visited group and 366 in the unvisited group) were included in this study. Preoperative on-site visits were associated with a decreased POD incidence (odds ratio [OR]: 0.524, 95% CI: 0.336-0.817), an improved POD severity (OR: 0.578, 95% CI: 0.359-0.932) and a shortening POD duration (OR: 0.972, 95% CI: 0.951-0.994). There was a significant difference between the visiting and non-visiting groups in the mechanical ventilation duration (OR: 0.987, 95% CI: 0.978-0.996). Preoperative on-site visits are associated with a reduction in the incidence, duration, and severity of POD, as well as the mechanical ventilation duration of patients. This study found that preoperative on-site visits were associated with the onset, duration, severity and duration of mechanical ventilation of POD. Although many factors influence the occurrence of POD, a multidisciplinary visiting team led by a nurse (including CCU nurses and physicians) can provide early nursing interventions through preoperative visits, better obtain postoperative cooperation from patients, establish a good nurse-patient relationship and provide better health services to patients. In a realistic CCU setting, nurses and physicians can act as educators, assessing patients before surgery, enhancing preoperative education, improving patient familiarity with the CCU environment and teaching sign language communication skills when patients are mechanically ventilated. These findings can therefore provide the basis for effective clinical care to prevent postoperative POD.

Postoperative Delirium after Reconstructive Surgery in the Head and Neck Region.

Postoperative delirium (POD) is an acute and serious complication following extended surgery. The aim of this study was to identify possible risk factors and scores associated with POD in patients undergoing reconstructive head and neck surgery. A collective of 225 patients was retrospectively evaluated after receiving reconstructive surgery in the head and neck region, between 2013 to 2018. The incidence of POD was examined with regards to distinct patient-specific clinical as well as perioperative parameters. Uni- and multivariate statistics were performed for data analysis. POD occurred in 49 patients (21.8%) and was strongly associated with an increased age-adjusted Charlson Comorbidity Index (ACCI) and a prolonged stay in the ICU (p = 0.009 and p = 0.000, respectively). Analogous, binary logistic regression analysis revealed time in the ICU (p &lt; 0.001), an increased ACCI (p = 0.022) and a Nutritional Risk Screening (NRS) score ≠ 0 (p = 0.005) as significant predictors for a diagnosis of POD. In contrast, the extent of reconstructive surgery in terms of parameters such as type of transplant or duration of surgery did not correlate with the occurrence of POD. The extension of reconstructive interventions in the head and neck region is not decisive for the development of postoperative delirium, whereas patient-specific parameters such as age and comorbidities, as well as nutritional parameters, represent predictors of POD occurrence.

Abstract 14220: Incidence of Delirium After Transcatheter Aortic Valve Replacement

Introduction: Patients who undergo transcatheter aortic valve replacement (TAVR) often are elderly, frail and with comorbid conditions. Delirium is frequently encountered in older adults and is associated with increased morbidity and mortality. Hypothesis: The purpose of this study is to determine the clinical significance of postoperative delirium in patients with aortic stenosis undergoing TAVR. Methods: The National Inpatient Sample was queried from 2011-2019 for relevant ICD-9 and ICD-10 codes to identify patients who underwent TAVR. Baseline characteristics and in-hospital outcomes between patients with and without delirium were compared. Logistic regression was performed to adjust for pre-specified co-variates for mortality and other in-hospital outcomes. p-value was considered significant when &lt;0.001. Results: We identified a weighted sample of 270,178 patients who underwent TAVR, of which 5,059 (1.9%) had a diagnosis of delirium. Baseline characteristics are shown in Table 1. Patients who had delirium after TAVR had a higher mortality risk (3% vs 1.8%), had a longer LOS (median 7 vs 3 days) and higher expenditures (median $220,046 vs $179,166, p&lt;0.001 for all). When adjusted for significant comorbidities, the odds ratio (OR) for mortality was 1.303 (CI [1.1-1.5]) with a LOS OR of 1.065 (CI [1.062-1.068], p&lt;0.001 for both. Conclusions: Delirium after TAVR is associated with higher in-hospital mortality, prolonged hospital stay and higher hospital expenditures. A structured approach focused on prevention and early recognition of delirium may be warranted.

Premedication with midazolam in low-risk surgery in children does not reduce the incidence of postoperative delirium. Cohort study

Introduction: Pediatric postoperative delirium is a frequent complication for which preventive pharmacological measures have been suggested. The use of midazolam as a prophylactic strategy has not yet been thoroughly assessed. Notwithstanding the fact that it is used in pediatric presurgical separation anxiety, its role in delirium is yet to be established. &#x0D; Objective: To quantify the incidence of pediatric postoperative delirium in patients undergoing low risk surgical interventions, exposed to oral midazolam-based premedication and to explore the protective and risk factors associated with the development of delirium. &#x0D; Materials and methods: Prospective, analytical observational study with a cohort design. Children were conveniently selected in accordance with the daily list of surgical procedures in the operating rooms. The inclusion criteria were children between 2 and 10 years old, ASA I-II, undergoing low risk surgeries. Concurrent and longitudinal follow-up was then conducted upon admission to the post-anesthesia care unit (PACU) for the first hour.&#x0D; Results: A total of 518 children were included. The overall incidence of delirium was 14.4 % (95 % CI: 11.4 %-17.5 %). In the subgroup exposed to midazolam, 178 children were analyzed, with an incidence of delirium of 16.2% (95% CI of 10,8 %-21,7). These patients exhibited a higher tendency to delirium with the use of sevoflurane or fentanyl, and/or when presenting with severe postoperative pain. Patients exposed to propofol and/or remifentanil showed lower incidences.&#x0D; Conclusions: No reduction in the incidence of emergency pediatric delirium associated with the use of pre-surgical oral midazolam in low risk surgical procedures. Prospective controlled trials and additional research are required to study the effectiveness and safety of this intervention.

Postoperative Delirium in Patients Receiving Hip Bipolar Hemiarthroplasty for Displaced Femoral Neck Fractures: The Risk Factors and Further Clinical Outcomes

BackgroundPostoperative delirium in patients who have hip fractures may lead to poor outcomes. This study aimed to determine perioperative risk factors and clinical outcomes of postoperative delirium in patients undergoing hip bipolar hemiarthroplasty for displaced femoral neck fractures. MethodsAmong 1,353 patients who underwent hemiarthroplasty at our institution during 2013-2021, we identified 78 patients with postoperative delirium diagnosed with the confusion assessment method. The mean delirium duration was 28 hours (range: 15-520). We also included 1:2 sex- and age-matched patients who did not have postoperative delirium after the same surgery as a matching cohort for comparison. Patient comorbidities, perioperative data, delirium occurrence, and outcomes were collected for analyses. ResultsA Charlson Comorbidity Index (CCI) score ≥6 (odds ratio (OR): 2.08, P = .017), nighttime surgery (OR: 3.47, p =<.001), surgical delays (OR: 1.01, P = .012), preoperative anemia (OR: 2.1, P = .012), and blood transfusions (OR: 2.47, P = .01) may increase the risk of postoperative delirium. The presentation of delirium was associated with sepsis (OR: 3.77, P = .04), longer hospital stays (P < .001), higher 1-year mortality (OR: 3.97, P = .002), and overall mortality (OR: 2.1, P = .02). ConclusionPostoperative delirium predicted poor outcomes. Our results emphasized the importance of early identification of patients at risk and optimization of the medical conditions before and after surgery.

Risk Factors for Acute Postoperative Delirium in Cardiac Surgery Patients >65 Years Old

Background: Acute postoperative delirium is the most common neuropsychiatric disorder in cardiac surgery patients in the intensive care unit (ICU). The purpose of this study was to evaluate the possible risk factors of postoperative delirium (POD) for cardiac surgery patients in the ICU. Materials and Methods: The study population was composed of 86 cardiac surgery patients managed postoperatively in the cardiac surgery ICU. Presence of POD in patients was evaluated by the CAM-ICU scale. Results: According to the CAM-ICU scale, 22 (25.6%) patients presented POD; history of smoking, alcohol use, COPD, and preoperative permanent atrial fibrillation were associated with POD (for all, p < 0.05). The type of cardiac surgery operations, type of analgesia, and red blood cell transfusion in the ICU were not associated with POD (p > 0.05), while cardiac arrhythmia in the ICU, hypoxemia in the ICU after extubation (pO2 < 60 mmHg), and heart rate after extubation were predisposing factors for POD (for all, p < 0.05). Multivariable logistic regression analysis (adjusted to risk factors) showed that hypoxemia after extubation (OR = 20.6; 95%CI: 2.82–150), heart rate after extubation (OR = 0.95; 95% CI: 0.92–0.98), and alcohol use (OR = 74.3; 95%CI: 6.41–861) were predictive factors for acute postoperative delirium (for all, p < 0.05). Conclusion: Alcohol use and respiratory dysfunction before and after heart operation were associated with acute postoperative delirium in cardiac surgery ICU patients.

Response: Commentary: Preoperative status of gut microbiota predicts postoperative delirium in patients with gastric cancer.

Response: Commentary: Preoperative status of gut microbiota predicts postoperative delirium in patients with gastric cancer.

Anxiety as a Risk Factor for Postoperative Delirium in Elective Spine Deformity Surgeries: A National Database Study.

IntroductionGeneralized anxiety disorder has become one of the most prevalent mental health disorders in the United States. In addition, postoperative delirium has been shown to increase hospital stay, increase mortality, and increased healthcare costs. Few studies have looked at the prevalence of postoperative delirium in patients diagnosed with anxiety undergoing elective spinal deformity procedures. The purpose of this study was to determine if anxiety is a risk factor for postoperative delirium in elective spinal deformity surgeries.MethodsThe authors performed a retrospective analysis using the TriNetX Research Database. Patients diagnosed with kyphosis or lordosis who then underwent elective spinal correction surgeries were identified. This group was then separated based on the diagnosis of a generalized anxiety disorder before the operation versus no diagnosis. Propensity score adjustment, based on mental disorders and other risk factors, was then used to match cohorts on baseline demographics and characteristics. Analysis was performed on the primary outcome of postoperative delirium, with secondary outcomes of upper respiratory tract infections, surgical site infections, sepsis, ventilator dependence, convulsions, stroke, emergency department visits, myocardial infarction, pulmonary embolism, and urinary retention within 30 days after surgery.ResultsOur search included 1,211 patients with a diagnosis of anxiety and 8,055 patients without anxiety. After propensity score matching, 996 patients remained in each cohort. Statistical analysis showed significant outcomes between the matched cohorts in the anxiety group for postoperative delirium (OR 2.788; 1.587-4.899) and convulsions (OR 1.615; 1.006-2.592). All other outcomes were not significant after propensity score matching.ConclusionThese results showed generalized anxiety disorder is a risk factor for postoperative delirium and convulsions after elective spine surgery. Further research is necessary on the effects of mental health disorders on postoperative delirium and other outcomes to better understand the risks in this population.

Association of electroencephalogram epileptiform discharges during cardiac surgery with postoperative delirium: An observational study.

BackgroundDelirium is a frequent and serious complication following cardiac surgery involving cardiopulmonary bypass (CPB). Electroencephalography reflects the electrical activity of the cerebral cortex. The impact of electroencephalographic epileptiform discharges during cardiac surgery on postoperative delirium remains unclear. This study was designed to investigate the relationship between intraoperative epileptiform discharges and postoperative delirium in patients undergoing cardiac surgery.MethodsA total of 76 patients who underwent cardiac surgery under CPB were included. The baseline cognitive status was measured before surgery. Electroencephalograms were monitored continuously from entry into the operating room to the end of surgery. The presence of delirium was assessed through the Confusion Assessment Method or the Confusion Assessment Method for the Intensive Care Unit on the first 3 days after surgery. Univariate and multivariate logistic regression analyses were performed to evaluate the association between epileptiform discharges and delirium.ResultsDelirium occurred in 31% of patients and epileptiform discharges were present in 26% of patients in the study. Patients with delirium had a higher incidence of epileptiform discharges (52.63% vs. 13.95%, P < 0.001) and longer durations of anesthesia and CPB (P = 0.023 and P = 0.015, respectively). In addition, patients with delirium had a longer length of hospital stay and a higher incidence of postoperative complications. Multivariate logistic regression analysis showed that age and epileptiform discharges were significantly associated with the incidence of postoperative delirium [odds ratio, 4.75 (1.26–17.92), P = 0.022; 5.00 (1.34–18.74), P = 0.017, respectively].ConclusionsPostoperative delirium is significantly related to the occurrence of epileptiform discharges during cardiac surgery.

Risk factors for postoperative delirium on oxygen delivery-guided perfusion

BackgroundStudies have demonstrated the efficacy of oxygen delivery-guided perfusion (ODGP) in preventing postoperative acute kidney injury, but the benefit of ODGP for delirium has not been confirmed. We retrospectively investigated the risk factors for postoperative delirium in patients who underwent ODGP (with oxygen delivery index [DO2i] > 300 mL/min/m2).MethodsConsecutive patients who underwent on-pump cardiovascular surgery with ODGP from January 2018 to December 2020 were retrospectively analyzed. In addition to examining patients’ DO2i during cardiopulmonary bypass (CPB), we quantified the two primary DO2 components-hematocrit (Hct) and pump flow. Delirium was defined based on the Intensive Care Delirium Screening Checklist (ICDSC). Patients were divided into three groups: no delirium (ICDSC score = 0), subsyndromal delirium (ICDSC score = 1–3), and clinical delirium (ICDSC score ≥ 4).ResultsMultivariate analysis identified only the number of red blood cell (RBC) units transfused, intubation time, and the cumulative time below the Hct threshold of 25% as predictive factors of postoperative delirium. Although patients with higher ICDSC scores had greater hemodilution during CPB, ODGP resulted in a higher pump flow, and DO2i was maintained above 300 mL/min/m2, with no significant difference between the three groups.ConclusionsA low Hct level during CPB with ODGP, the number of RBC units transfused, and intubation time were associated with postoperative delirium. Further investigations are needed to determine the ability of ODGP to prevent low Hct during CPB.

The C-reactive protein/albumin ratio predicts postoperative delirium in patients older than 60 years following total knee arthroplasty.

PurposeThis study aimed to investigate the relationship between serum C-reactive protein (CRP)/Albumin ratio (CAR) and postoperative delirium (POD) in patients older than 60 years following total knee arthroplasty (TKA).MethodsFrom January 2019 to January 2021, 268 patients were recruited in this prospective observational investigation. Patients with serum CRP, Alb, CAR, delirious status and delirious score were assessed. The effect of CRP, Alb, CAR on predicting delirium was assessed with the area under the receiver operating characteristic (ROC) curve (AUC).ResultsThe study found that higher CRP level (P < 0.001), low Alb level (P < 0.001), and higher CAR (P < 0.001) were independently associated with POD. The AUC of CAR for POD was 0.782, with the cut-off value of 0.117, a sensitivity of 83.3% and a specificity of 65.9% respectively (P < 0.001), suggesting that CAR had moderate efficacy on predicting POD occurrence than CRP (AUC: 0.761) and Alb (AUC: 0.300). The results also showed that age, ASA and the operation time was an independent predictor for patients with POD.ConclusionsOur findings demonstrated CAR may be an effective biomarker to predict postoperative delirium in patients over 60 years of age with TKA, which provides potential recommendations for early intervention in delirium care.

Risk factors for delirium after surgery for craniocerebral injury in the neurosurgical intensive care unit

BACKGROUNDPostoperative delirium is common in patients who undergo neurosurgery for craniocerebral injury. However, there is no specific medical test to predict postoperative delirium to date.AIMTo explore risk factors for postoperative delirium in patients with craniocerebral injury in the neurosurgery intensive care unit (ICU). METHODSA retrospective analysis was performed in 120 patients with craniocerebral injury admitted to Hainan People’s Hospital/Hainan Hospital Affiliated to Hainan Medical University, The First Affiliated Hospital of Hainan Medical University, and The Second Affiliated Hospital of Hainan Medical University between January 2018 and January 2020. The patients were categorized into groups based on whether delirium occurred. Of them, 25 patients with delirium were included in the delirium group, and 95 patients without delirium were included in the observation group. Logistic regression analysis was used to explore the association between sex, age, educational level, Glasgow coma scale (GCS), complications (with or without concussion, cerebral contusion, hypoxemia and ventricular compression) and site of injury and delirium. RESULTSThe GCS score above 8 and concomitant disease of cerebral concussion, cerebral contusion, hypoxemia and ventricular compression, and damage to the frontal lobe were associated with delirium in patients admitted to neurosurgical intensive care unit (ICU) (all P < 0.05). However, age, sex, administration more than three medicines, and educational level were not significantly associated with the onset of delirium in patients with craniocerebral injury in the neurosurgical ICU (P < 0.05). Multivariate logistic regression analysis showed that GCS score above 8, cerebral concussion, cerebral contusion, hypoxemia, ventricle compression, and frontal lobe disorders were independent risk factors for delirium in patients with craniocerebral injury in the neurosurgical ICU (P < 0.05).CONCLUSIONGCS score, concussive concussion, cerebral contusion, hypoxemia, ventricle compression, and damage to frontal lobe are risk factors of postoperative delirium.