Regular Research ArticlesIncidence and Predictors of Post-Cardiotomy Delirium
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
References (42)
- et al.
Delirium after cardiac surgery: a critical review
J Psychosom Res
(1996) - et al.
Post-operative delirium: A review of 80 primary data-collection studies
Arch Intern Med
(1995) - et al.
Predictors of delirium after cardiac surgery delirium: Effect of beating-heart (off-pump) surgery
J Thorac Cardiovasc Surg
(2004) - et al.
The Veterans Affairs continuous improvement in cardiac surgery study
Ann Thorac Surg
(1994) - et al.
A critique of instruments and methods to detect, diagnose, and rate delirium
J Pain Symptom Manage
(1995) A review of delirium assessment instruments
Gen Hosp Psychiatry
(1994)- et al.
Mini-mental state: A practical method for grading the cognitive state of patients for the clinician
J Psychiatr Res
(1975) - et al.
A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation
J Chron Dis
(1987) - et al.
Delirium, a syndrome of cerebral insufficiency
J Chron Dis
(1959) Delirium in elderly patients
Am J Geriatr Psychiatry
(2004)
Preoperative risk factors for post-operative delirium
Gen Hosp Psychiatry
Early symptoms in the prodromal phase of delirium: A prospective cohort study in elderly patients undergoing hip surgery
Am J Geriatr Psychiatry
Subsyndromal delirium
Am J of Geriatr Psychiatry
Predictors and outcomes of delirium
Gen Hosp Psychiatry
The effects of post-operative pain and its management on post-operative cognitive dysfunction
Am J Geriatr Psychiatry
Atherosclerosis is associated with delirium after coronary artery bypass graft surgery
J Am Geriatr Soc
A clinical prediction rule for delirium after elective noncardiac surgery
JAMA
Postcardiotomy delirium: conclusions after 25 years
Am J Psychatry
Delirium risk factors in elderly hospitalized patients
J Gen Intern Med
Incidence and risk factors for delirium and other adverse outcomes in older adults after coronary artery bypass graft surgery
Can J Cardiol
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The authors thank James Rudolph, Cheryl Farmer, and Deborah Johnson for their help in carrying out this study.