Regular Research Articles
Incidence and Predictors of Post-Cardiotomy Delirium

https://doi.org/10.1097/JGP.0b013e318172b418Get rights and content

Objective

To determine the incidence and predictors of delirium after cardiac surgery.

Method

A prospective, observational study of postcardiotomy surgical patients was conducted during a 5 month period at the Minneapolis, MN, VAMC.

Results

Of the 53 patients who completed the study, 12 patients (23%) met criteria for postoperative delirium and 18 patients (34%) met criteria for postoperative subsyndromal delirium. Significant predictors of postoperative delirium included a history of cerebrovascular disease (Charlson Index item, VA CICSP), high medical comorbidity (VA morbidity risk score, Charlson Index), increased preoperative creatinine level, and an increased preoperative pain rating. When delirium and subsyndromal delirium patients were combined, a history of cerebrovascular disease, left ventricular dysfunction, or diabetes predicted the development of delirious symptoms.

Conclusions

Incident delirium occurred in 23% of patients after cardiac surgery and incident delirium symptoms, in 57%. The strongest predictor of both incident delirium and delirium symptoms was a history of cerebrovascular disease.

Section snippets

Study Patients

From February 2006 to June 2006, 126 patients underwent elective cardiac surgery at the Minneapolis, MN, VA Medical Center. Of these, 76 were asked to participate in the study. Seventeen patients refused and the remaining 59 subjects were enrolled and provided written informed consent. Of these, 53 patients (53 M, 0 F; 52 Caucasians, 1 American Indian) completed the study. Of the 6 who did not complete the study, 2 patients were excluded due to inability to participate in daily assessments,

RESULTS

Twelve of the 53 patients (23%) who completed the study met CAM criteria for a diagnosis of delirium during the postoperative period (Table 1). Patients with delirium had a significantly longer length of stay in the ICU (4.9 ± 2.7 days (mean ± SD) versus 2.6 ± 2.3 days, Mann-Whitney z = 2.89, N = 53, p = 0.004) and the hospital (16.1 ± 14.2 days versus 9.1 ± 5.6 days, Mann-Whitney z = 2.40, N = 53, p = 0.016). Comparisons between delirious and nondelirious patients on preoperative and

DISCUSSION

In this prospective observational study of 53 male veterans who underwent cardiac surgery, the incidence of frank postcardiotomy delirium (PCD) was 23% (12 out of 53 patients). A past history of cerebrovascular disease (Charleson Index item and CICSP), creatinine level, total Charlson Index score, VA morbidity score, and a mildly increased preoperative pain rating scale were found to be predictive of PCD. It is important to note that out of a total of 9 patients with past history of stroke or

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      Patients undergoing cardiovascular surgical procedures are at higher risk of developing agitated delirium due to several factors, including: surgical complexity, co-morbidities, and age [2,3,8]. Some of the factors that are particular to cardiac surgery include: pre-operative EURO-Score [1], length of stay in the ICU [9], prolonged mechanical ventilation [15], prolonged aortic cross clamp time [11], undergoing valve surgery [14], history of cerebrovascular disease [10], left ventricular dysfunction [10], and diabetes mellitus [10]. The biggest issue with these risk factors is that most of them are based on an observational small cohort of patients (44–142 patients).

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    The authors thank James Rudolph, Cheryl Farmer, and Deborah Johnson for their help in carrying out this study.

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