Predictors of delirium after cardiac surgery delirium: effect of beating-heart (off-pump) surgery.

Abstract

BACKGROUND:

Despite improved outcomes after cardiac operations, postoperative delirium remains a common complication that is associated with increased morbidity and prolonged hospital stay.

METHODS:

Univariate and multivariate predictors of postoperative delirium were determined from prospectively gathered data on 16,184 patients undergoing cardiac operations with cardiopulmonary bypass (conventional, n = 14,342) and without cardiopulmonary bypass (beating-heart surgery, n = 1847) between April 1996 and August 2001. Delirium was defined as a transient mental syndrome of acute onset characterized by global impairment of cognitive functions, a reduced level of consciousness, attentional abnormalities, increased or decreased psychomotor activity, and a disordered sleep-wake cycle.

RESULTS:

The overall prevalence of postoperative delirium was 8.4%. Of 49 selected patient-related risk factors and treatment variables, 35 were highly associated with postoperative delirium by univariate analysis. Stepwise logistic regression revealed the following variables as independent predictors of delirium: history of cerebrovascular disease, peripheral vascular disease, atrial fibrillation, diabetes mellitus, left ventricular ejection fraction of 30% or less, preoperative cardiogenic shock, urgent operation, intraoperative hemofiltration, operation time of 3 hours or more, and a high perioperative transfusion requirement. Two variables were identified as having a significant protective effect against postoperative delirium: beating-heart surgery and younger patient age.

CONCLUSIONS:

Postoperative delirium is a common complication in cardiac operations. The increased use of beating-heart surgery without cardiopulmonary bypass may lead to a lower prevalence of this complication and thus improve patient outcomes.

• Authors: Jan Bucerius, Jan F Gummert, Michael A Borger, Thomas Walther, Nicolas Doll, Volkmar Falk, Dierk V Schmitt, Friedrich W Mohr
• Journal: The Journal of thoracic and cardiovascular surgery (J Thorac Cardiovasc Surg) Vol. 127 Issue 1 Pg. 57-64 (Jan 2004) ISSN: 0022-5223 [Print] United States
• PMID: 14752413 (Publication Type: Comparative Study, Journal Article)

Topics

• Age Distribution
• Aged
• Aged, 80 and over
• Analysis of Variance
• Cardiac Surgical Procedures (adverse effects, methods)
• Cardiopulmonary Bypass (adverse effects, methods)
• Cohort Studies
• Coronary Artery Bypass (adverse effects, methods)
• Delirium (epidemiology, etiology)
• Female
• Humans
• Logistic Models
• Male
• Middle Aged
• Multivariate Analysis
• Odds Ratio
• Postoperative Complications (diagnosis, epidemiology)
• Predictive Value of Tests
• Prevalence
• Probability
• Prospective Studies
• Sex Distribution
• Survival Analysis